(navigation image)
Home American Libraries | Canadian Libraries | Universal Library | Community Texts | Project Gutenberg | Children's Library | Biodiversity Heritage Library | Additional Collections
Search: Advanced Search
Anonymous User (login or join us)
Upload
See other formats

Full text of "The American journal of the medical sciences"

THE 



AMERICAN JOURNAL 



* OF THE 



MEDICAL SCIENCES. 



No. XI.— May, 1830. 1 



COLLABORATORS. 



Jacob Bigelow, M. D. Professor of 
Materia Medlca in Harvard Univer- 
sity, Boston. 

Edward H. Babton, M. D. of St. 
Francisvilk, Louisiana. 

AValter Channing, M. D. Professor of 
Midwifery and Legal Medicine in 
Harvard University, Boston. 

N. Chapman, M. D. Professor of the 
Institutes and Practice of Physic and 
Clinical Practice in the University of 
Pennsylvania. 

JoHX Redman Coxe, M. D. Professor 
of Materia Medica and Pharmacy in 
the University of Pennsylvania. 

William C. Daniell, M. D. of Savan- 
nah, Georgia. 

E. De Butts, M. D. Professor of Che- 
mistry in the University of Mary- 
land. 

William P. Dewees, M. D. Adjunct 
Professor of Midiuifery in the Univer- 
sity of Pennsylvania. 

S. Henry Dickson, M. D. Professor of 
the Institutes and Practice of Medicine 
in the Medical College of South Caro- 
lijia. 

Benjamin W. Dudley, M. D. Profes- 
sor of Anatomy and Surgery in Tran- 
sylvania University. 

GouYEBNEUR Emebson, M. D. of Phila- 
delphia. 

Thomas Fearn, M. D. of Alabama. 

John W. Francis, M. D. Professor of 
Obstetrics and Forensic Medicine in 
Rutgers Medical College, New York. 

E. Geddings, M. D. Lecturer on Anato- 
my and Surgery, Charleston, South 
Carolina. 

William Gibson, M. D. Professor of 
Surgery in the University of Pennsyl- 
vania. 

John D. Godman, M. D. late Prof essor of 
Anatomy and Physiology in Rutgers 
Medical College, New York. 

II. E. GniTT^iTH,M.I>. of Philadelphia. 

E. Hale, M. D. of Boston. 

TloBERT Hare, M. D. Professor of Che- 
mistry in the University of Pennsyl- 
vania. 

Isaac Hats, M. D. one of the Surgeons 
of the Pennsylvania Infirmary fw 
diseases of the Eye and Ear. 



George Haiward, M. D. of Boston. 

Thomas Henderson, M. D. Professc/r 
of the Theory and Practice of Medi- 
cine in the Columbian College, Dis- 
trict of Columbia. 

William E. Horner, M. D. Adjunct 
Professor of Anatomy in the Univer- 
sity of Pennsylvania. 

Dayid Hosack, M. D. Professor of the 
Institutes and Practice of Medicine in 
Rutgers Medical College, New York. 

Ansel W. Ives, M. D. of New York. 

Samuel Jackson, M. D. Assistant to the 
Professar of the Institutes and Practice 
of Medicine and Clinical Practice in 
the University of Pennsylvania. 

Samuel Jackson, M. D. of Northum- 
berland, Pennsylvania. 

W. J. Macneven, M. D. Professor of 
The7'apeutics and Materia Medica in 
Rutgers Medical College, New York. 

C. B, Matthews, M. J}, of Philadelphia. 

Valentine Mott, M. D. Professor of 
Surgery in Rutgers Medical College, 
New York. 

James Moultrie, Jr. M. D. of Charles- 
ton, S. C. 

Reuben D. Mussey, M. D. Professor 
of Anatomy and Surgery in Dart- 
niouth College, New Hampshire. 

James M. Pendleton, M. D. Lecturer 
on Midwifery and Diseases of Women 
and Children, New York. 

Philip Syng Physick, M. D. Profes- 
sor of Anatomy in the University of 
Pennsylvania. 

Nathaniel Potter, M. D. Professor of 
the Theory and Po-actice of Medicine 
in the University of Maryland 

Thomas Sewall, M. D. Professor of 
Anatomy and Physiology in the Co- 
lumbian College, District of Columbia. 

John AVare, M. D. of Boston. 

John C. AVarren, M. D. Professor of 
Anatomy and Surgery in Harvard 
University, Boston. 

J. Webster, M. D. Lecturer on Ana- 
tomy and Surgery, Philadelphia. 

N, A'V. Wobthington, M. D. Professor 
of Materia Medica in the Columbian 
College, District of Columbia. 

Thomas H. Wright, M, D. Physician to 
the Baltimore Aims-House Infirmary. 



THE 



AMERICAN JOURNAL 



OF THE 



MEDICAL SCIENCES 



VOL. VI. 



PHILADELPHIA: 
CAREY & L.EA 

1830. 



V. ^ 



TO READERS AND CORRESPONDENTS. 



Dr. Wright's Paper on the Use of the Warm Bath in Autumnal Fever, in 
our next. 

The Reviews of the second volume of Carus's Gynaecology, of Macculioch 
on Malaria, and of Yelpeau's Traite de I'Art des Accouchemens, intended for 
the present number, were not prepared in time. 

Several Bibliographical Notices intended for this number have been crowd- 
ed out. 

The Case, supposed to be Traumatic Tetanus, cured by quinine and opium, 
was evidently not an instance of that disease. The supposed tetanic symptoms 
appeared immediately after a cut on the arm, and had ceased by the fifth day, 
some time before the symptoms of traumatic tetanus make their appearance. 

We have received the following publications: — 

Des Hemorroi'des, ou Traite Analytique de toutes les affections HemorroY- 
dales. Par A. J. de Mo]?fTEGiiE, M. D. P. 2d ed. publiee par sa neuve. Paris, 
1830. Madelle. Delauney. 

Memoire sur I'Angine Epidemique, ou Diphtherite. Par F. P. Emaa'gard, 
D. M. P. Paris, 1829. Madelle. Delauney. 

Considerations Generales sur TEtat Actuel de la Medecine. Par M. R. Char- 
BON-MER, D. M. P. Paris, 1829. Madelle. Delauney. 

De la Destruction Mecanique de la Pierre dans la Vessie ou Considerations 
Nouvelles sur la Lithotritie. Par J. J. A. Rigai. Paris, 1829. Gabon. 

Atlas Historique et Bibliographique de la Medecine, compose de tableaux 
sur I'Histoire de TAnatomie, de la Physiologic, de I'Hygiene, de la Medecine, 
de la Chirurgie et de I'Obstetrique, &c. Par Casimir Broussais, D. M. P. Chi- 
rurgien Aide-Major du Gymnase Normal Militaire et Civile, &c. Paris, 1829, 
Madelle. Delauney. 

Precis Analytique et Raisonne du Systeme duDocteur Gale sur les Facultes 
de I'Homme et les Fonctions du Cerveau, Yulgairement Cranoscopie. Redige 
sur les Indications Fournies. Par Dr. Gaii, lui-meme a I'auteur. Q,uatrieme 
edition, considerablement augmentee et amelioree. Paris, 1829. Rouen freres, 
12mo. 

Anthropogenese ou Generation de I'Homme, avec des vues de Comparison 
sur les Productions des trois regnes de la Nature, et desRecherches sur la Con- 
servation des especes et des races, les ressemblances sexuelles et autres, les 
croisement des races, les causes de la fecondite, de la stirilite, de I'impuissance, 
et sur d'autres phenomenes des revivifications naturelles. Par J. B. Deman- 
GEON-, Docteur en Philosophic et en Medecine, &c. Paris, 1829. Rouen freres, 
Svo. 

No. XL— May, 1830. 2 



6 TO READERS AND CORRESPONDENTS, 

A Biographical Memoir of Josiah Goodhue, M. D. late President of the 
Berkshire Medical Institution, delivered at the close of an introductory lecture 
on the 20th of November, 1829. By Stephen W. Williams, M. D. Professor 
of Medical Jurisprudence in the Berkshire Medical Institution. (From the au- 
thor.) 

Transactions of the Medical Society of the state of New York for the year 
1830. With the Annual Address. By T. Rometn Beck, M. D. President of the 
Society. Albany, 1830. (From the Society.) 

An Enquiry into the Present System of Medical Education in the State of 
New York. Respectfully submitted to the consideration of the members of the 
Legislature. Albany, 1830. 

Address to the Community on the Necessity of Legalizing the Study of Ana- 
tomy. By order of the Massachusetts Medical Society. Boston, 1829. 

Charge addressed to the Graduates in Medicine at the commencement of the 
Medical Department of the Columbian College, D. C. March 10, 1830. By 
Thomas P. Jones, M. D. Professor of Chemistry, and Dean of the Medical Fa- 
culty. (From the author. ) 

A Manual of Midwifery; or a Summary of the Science and Practice of Obste- 
tric Medicine. By Michael Ryan, M. D. Second edition. London. Thomas 
and George Underwood, 1829. 

Journal des Progres des Sciences et Institutions Medicales en Europe en 
Amerique, &c. Tome XVIII. and Vol. I. Second series. (In exchange.) 

Archives Generales de Medecine; Journal pubUee par une Soclete de Mede- 
cins. November, December. (In exchange.) 

Bulletin des Sciences Medicales, redlge par M. Defekmok". August, Sep- 
tember, October, November. (In exchange.) 

La Clinlque, Annales de Medecine Universelle. Par une Societe de Medeclns 
Frangais et Etrangeres. Tom. I. No. 35 to 43 inclusive, and Vol. II. No. 1 to 
22 inclusive. 

La Clinlque, Annales de Medecine Universelle. Bulletin Bibliographique de 
Medecine et des Sciences Accessolres. No. I. (In exchange.) 

Nouvelle Bibllotheque Medlcale, Journal de Medecine et de Chirurgie Pra- 
tiques. November, December, 1829. (In exchange.) 

Journal General de Medecine, de Chirurgie, et de Pharmacie Frangals et 
Etrangeres; ou recuil Periodique des travaux de la Societe de Medecine de Pa- 
ris, redlge par A. N. Gendrik. December, 1829, January, February, 1830. 
(In exchange.) 

Revue Medicalcj Franpals et Etrangere, et Journal de Clinlque de I'Hotel- 
Dieu, de la Charite, et des Grands Hopitaux de Paris. January, February, March, 
April, May, November, December, 1829, and January, 1830. (In exchange.) 

Journal de Chimie Medlcale, de Pharmacie et de Toxicologic, redlge par les 
membres de la Societe de Chimie Medlcale. July, December, 1829. (In ex- 
change.) 



TO READERS AND CORRESPONDENTS. 7 

Annales de la Medecine Physiologlque. October, November, December, 
,1829, January, 1830. (In exchang-e.) 

Memorial des Hopitaux du Midi, et de la Clinique de Montpelier. Par le 
Prof. Delpech. January, February, March, April, May, June, July, August, 
September, October, November, 1829, and January, 1830. (In exchange.) 

Repertoire General d' Anatomic et de Physiologie Pathologiques et de Cli- 
nique Chirurgicale. Tome VII. 2d Trimestre de 1829, 

Journal Universel des Sciences Medicales. December, 1829, January, 1830. 
(In exchange.) 
London Medical and Surgical Journal, for October, November, December, 

1829, and January, February, 1830. (In exchange.) 

Edinburgh Medical and Surgical Journal, January, 1830. (In exchange.) 
The Medico-Chirurgical Review, January, 1830. (In exchange.) 

The London Medical Gazette, December, 1829, and January and February, 

1830. (In exchange.) 

The London Medical and Physical Journal, January, February. (In exchange. ) 

The Glasgow Medical Journal, edited by William Mackenzie, Lecturer on 
the Eye in the University of Glasgow. Nos. 5, 6, 7, and 8, for 1829. (In ex- 
change.) 

The Glasgow Medical Journal, conducted by Akdrew BucHANAif, M. D. and 
William Wieh, M. D. February, 1830. (In exchange.) 

The Midland Medical and Surgical Reporter, and Topographical and Statis- 
tical Journal, November, 1829, and February, 1830. (In exchange.) 

The Western Journal of the Medical and Physical Sciences, January, 1830. 
(In exchange.) 

The Transylvania Journal of Medicine and the Associate Sciences, February, 
1830. (In exchange.) 

The North American Medical and Surgical Journal, April, 1830. (In exchange.) 

The Boston Medical and Surgical Journal, Vol. III. Nos. 1 to 10. 

For the gratification of our contributors we continue the references to the 
works, in which they will find notices to their communications; these references 
are, of course, restricted to the Journals received during the preceding three 
months. 

Professor Phtsick will find his Case of Obstinate Cough from Elongation of 
the Uvula, noticed in the Revue Medicale for February, 1829. 

Professor Mott's Case of Immobility of the Lower Jaw is republished in the 
London Medical and Surgical Journal for March, 1830. 

Professor Dewees*s Essay on Phlegmasia Dolens is noticed in the Lyndon 
Medical and Surgical Journal for March, 1830. 

Professor Bigelow*s Method of affording Respiration to Children in Reversed 
Presentations is noticed in the Memorial des Hopitaux du Midi for January, 



8 TO READERS AND CORRESPONDENTS. 

1830; the London Medical and Surgical Journal, November, 1829; and the 
London Medical and Physical Journal for February, 1830. 

Professor Mussex's Experiments on Colouring- Foetal Bones with Madder are 
noticed in the Western Journal of the Medical and Physical Sciences for Ja- 
nuary, 1830. 

Professor Coxe's Memoir on the Plant which furnishes the Officinal Jalap is 
noticed in the Journal of the Colleg-e of Pharmacy, Vol. II. No. 1.; and in the 

North American Medical and Surgical Journal for April, 1830. 

Professor Sewall's Communication on the Use of Turpentine in Hernia is 
noticed in the Journal des Progres, Vol. XVIII. ; and in the Memorial des Ho- 
pitaux for January, 1830. 

Professor Jackson's Cases of Cynanche Trachealis are noticed in the Medico- 
Chirurgical Review for January, 1830; and in the Western Journal of the Medi- 
cal and Physical Sciences for January, 1830. His Case of Amnesia is repubhsh- 
ed in the Journal Universel for July, 1829. 

Dr. Wright's Case of Aortal Aneurism is republished in the London Me- 
dical and Physical Journal for January, 1830, and his Case of Gangrene of the 
Lower Extremities is noticed in the Memorial des Hopitaux for January, 1830. 

Dr. Jackson's Case of Entropion is noticed in the Western Journal of the 
Medical and Physical Sciences for January last. 

Dr. Daniell's Mode of treating Fractured Bones is noticed in the Memorial 
des Hopitaux, and the Western Journal of the Medical and Physical Sciences 
for January, 1830. 

Dr. Ware's Case of Sea-sickness is noticed in the Boston Journal for March 
last. 

Dr. Hetjstis's Case of Cerebral Hernia is noticed in the Journal des Progres, 
Tom. XVIII. 

Dr. SiMMONs's Observations on Pyroligneous Acid are noticed in the Boston 
Medical and Surgical Journal for March last. 

Dr. Caleaghan's Account of the Small-pox Epidemic in Western Pennsylva- 
nia is noticed in the Western Journal of the Medical and Physical Sciences for 
January, 1830. 

Dr. Fahnestock's Paper on the use of the Rhus Glabrum as a Remedy for 
Ptyalism, is noticed in the London Medical and Surgical Journal for March, 
1830; and in the Western Journal of the Medical and Physical Sciences. 

Dr. Howe's Case of Tracheotomy is noticed in the Revue Medicale for 1829. 

Dr. Peirce's Case of Perforation of the Stomach is noticed in the Memorial 
des Hopitaux for January, 1830; in the London Medical and Surgical Journal 
for November, 1829; and in the Journal des Progres, Vol. XVIII. 

Dr. Levert's Experiments on Metallic Ligatures are noticed in the Quarterly 
Journal of Science for January last. 

Dr. Byrne's Observations on the use of Tartar Emetic in Chorea, are noticed 
in the Boston Medical and Surgical Journal for March last. 



TO READERS AND CORRESPONDENTS. 9 

Dr. MiGHEL*s Case of Parturition complicated with Hydrops Ovarii, is noticed 
in the London Medical and Surgical Journal for March last. 

Dr. Archer's Account of a Purulent Ophthalmia is noticed in the Londoii 
Medical and Surgical Journal for March last. 

Dr. Henderson's Case of Disease of the Bones cured by Arsenic, is noticed 
in the Journal des Progres; and in the Journal Universel for January, 1830. 

Authors of new medical books, desirous of having them reviewed or noticed 
in this Journal at the earliest opportunity, are invited to transmit to the Editor 
a copy as soon after publication as convenient, when they will receive prompt 
attention. Under ordinary circumstances, very considerable delay is caused by 
the circuitous routes through which they are received. 

Papers intended for publication, should be sent, free of expense^ as early after 
the appearance of the Journal as possible, in order to be in time for the ensuing 
number. Such communications should be addressed to " Caret 8c Lea, Phi- 
ladelphia, for the Editor of the American Journal of the Medical Sciences." 
All letters on the business of the Journal to be addressed exclusively to the pub- 
lishers. 



2* 



CONTENTS* 



ORIGINAL COMMUNICATIONS. 

ESSAYS. 
ArTo Page. 

I. Observations on the Treatment of Delirium Tremens, and on the use of 
the Warm Bath in that Disease. By Thomas H. Wright, M. D. Physician 

to the Baltimore Alms-house Infirmary 17 

II. Extraordinary Case of Pregnancy in which the Foetus was Discharged 
through the Abdominal Parietes. By Joseph A. Toy, M. D. of Virginia 33 

III. Examination of the Nature and Effects of Malaria, and on the Patho- 
logy and Treatment of Malarial Fevers. By Edwin D. Faust, M. D. of 
Columbia, S. C. 38 

IV. Case of Fistulous Communication between the Vagina, Bladder, and 
Rectum. By Charles Byrne, M. D., U. S. Arsenal, near Baltimore - 70 

V. Inquiry into the Functions and Pathology of the Liver and Spleen, and 
Remarks on the Influence and Effects of Atmospheric Temperature as 
Connected with the Origin and Prevalence of Disease, &c. By J. W. 
Heustis, M. D. Author of Physical Observations and Medical Tracts and 
Researches on the Topography and Diseases of Louisiana; and of Medi- 
cal Facts and Inquiries on the Endemic Fevers of Alabama - - 73 

VI. Case of Paralysis, successfully treated with Moxas. By W. T. Talia- 
ferro, M. D. of Kentucky 99 

VII. Of the Pulse and its Modifications. By Samuel Jackson, M. D, Assistant 
to the Professor of the Institutes and Practice of Medicine and Clinical 
Practice in the University of Pennsylvania 104 

Vllt. Observations on Hematosis, with two Cases in which this Function 
was imperfectly performed. By Samuel Jackson, M. D. Assistant to the 
Professor of the Institutes and Practice of Medicine and Chnical Prac- 
tice in the University of Pennsylvania 114 

IX. Meteorological Observations, made in the City of Philadelphia, Lati- 
tude 39° 57\ and on the Island of Tinicum, eleven miles south-west from 
Philadelphia, Latitude 39° 48', for the year 1827. By George F. Leh- 
man, M. D. L^azaretto Physician of the Port of Philadelphia - - 126 

REVIEWS. 

X. 1. Corvisart, Essai sur les Maladies et les Lesions Organiques du Coeur 

et des gros Vaisseaux. 

2. Burns. Observations on some of the most frequent and important Dis- 
eases of the Heart, Sec. 

3. Bertin. Traite des Maladies du Coeur et de gros Vaisseaux. 

4. Reeder. A Practical Treatise on tlie Diseases of the Heart, &c. 

5. Brown. Medical Essays on the Diseases of the Heart, &c. 

6. Dundas. An Account of a Peculiar Disease of the Heart. — Med. Chi- 
rurg. Trans. Vol. I. 



12 CONTENTS. 

Page. 

7. Wells. On Rheumatism of the Heart.— Transactions of a Society for 
Improvement of Medical Knowledge, Vol. III. 

8. James. On Diseases of the Heart. — Med. Chirurg. Trans. Vol. VIII. 

9. Laennec. Treatise on the Diseases of the Chest, &c.&c. Translated 
from the French. By John Forbes, M. D. &c. &c. 

10. Martinet. Manual of Patholog-y, &c. &c.— Translated from the 
French. By Jones Quain> M. D. - 139 

BIBLIOGRAPHICAL NOTICES. 

XI. Beitrage zur genaueren Kenntniss und Unterscheidung der Kehlkopfs- 
und Luftrohren Schwindsuchten. Von Wilhelm Sachse, Grossherzoglich 
Mecklenburg-Schwerinschem Leibarzte und Medicinal-Rathe. Mit Kup- 
fern, Hannover, 1821. 

Considerations relative to the Diagnosis of Laryngeal and Tracheal Phthi- 
sis. By William Sachse, &c. 161 

XII. Researches; principally relative to the Morbid and Curative Effects of 
Loss of Blood. By Marshall Hall, M. D. F. R. S. E., &c. London, 1830, 
pp. 303. Bvo. 172 

XIII. Memoire sur I'Angine Epidemique, ou Diphtherite. Par F. P. Eman- 
gard, Docteur en Medecine de la Faculte de Paris, i. Paris, 1829, 8vo. 
pp. 90. 

Memoir on the Epidemic Angina, or Diphtheritis. By F. P. Emangard, 
M. D. Paris, 1829, 8vo. pp. 90 - - 181 

XIV. Tabialse Anatomico-Pathologicae modos omnes quibus partium Cor- 
poris Humani Omnium Forma Externa Atquse Interna a norma recedit, 
exhibeatis. Auctore J. F. Meckel. Fasc. primus cum Tab. (En. viii. Lip- 
sise, 1817. Fasc. secund. Tab. viii. 1820. Fasc. tertius. Tab. ix. 1822. 
Fasc. quart. Tab. viii. 1826 - - - 186 

XV. De la Destruction Mecanique de la Pierre dans la Vessie; ou Consi- 
derations Nouvelles sur la Lithotritie. Memoire lu a I'Institut, &c. Par 

J. J. A. Rigal, Paris, 1829, 8vo. pp. 97, plates III - - - - 188 

XVI. Ueber die Verletzungen des Rueckenmarkes, in Hinsicht aufihr Le- 
thaiitaets-Verhaltniss. Von Dr. John Ludwig Casper, Practischem Arzte 

in Berlin, Mehrer gelehrten gesellschaften Mitgliede. Berlin, 1823 192 

XVII. Precis Analytique et Raisonne du Systeme du Docteur Gall. Avec 
figures, 4e Edition. Paris, 1829, 12mo.pp. 248. pi. XVII - - 193 

XVtIt. System der Vergleichenden Anatomic. Von J. F. Meckel, Professor 
der Medicine, Anatomic und Physiologic, zu Halle, &c. 8cc. Erster Band 
AUgemeine Anatomic, Halle, 1821. Zweiter, dritter, und vierter Band, 
Besondern Anatomic, enhalterid die Skeletlehre, die Muskellehre und 
die Verdauungslehre Halle, 1824-25-28 und 29. 

A System of Comparative Anatomy. By J. F. Meckel, Professor of Ana- 
tomy, Medicine, and Physiology, in the University of Halle, &c. - 200 

XIX. Encyclopadisches Worterbuch der Medicinischen Wissenschaften. 
Herausgegeben von den Professoren der Medicinischen Facultat zu Ber- 
lin: C. F. V. Graefe, C. W. Hufeland, H. F. Link, K. A. Rudolphi, E. v. 
Siebold. Zweiter Band. (Ahnung Antimonium.) Berlin, 1828 - 202 



CONTENTS. 13 

Page. 

XX. Elemente der Allgemeinen Anatomie in Verbindung mit der AUege- 
meinen Zergliederangskunst. Von Dr. M. J. Weber, Professor und Pro- 
sector zu Bonn, Mehrerer Gelehrten Gesellschaften Mitgliede, &c. Mit 

• Steintafeln, Bonn, 1826. 

Elemente der Speciellen Anatomie in Verbindung mit der Speciellen Zer- 
gliederangskunst. Von Dr. M. J. Weber, &c. Zweiter theil Muskel- 
lehre, Bonn, 1828 203 

XXI. Opusculi di Chirurgia. Di Antonio Scarpa, Professore Eraerito, e 
Direttore della Facolta Medica della I. R. Universita di Pavia, Cavaliere 
dell insigne ordine Austriaco di Leopoldo, &c. &c. 2 vol. fol. Pavia, 
1825 - . - - ■ 205 

XXII. Nosologic und Therapie der Chirurgischen Krankheiten in Verbin- 
dung mit der Becstireibung der Chirurgischen Operationen; oder ge- 
sammte ausfuhrliche Chirurgie fUr praktische Aerzte und Wundaerzte. 
Von. C. J. Langenbeck, Ordeutlichen Prof, der Anatomie und Chirur- 
gie, &c. &c. Erster Band mit drey Kupfertafeln Goet. I. 1822, pp. 704, 
zweiter Band drey Kupfertafeln Greet. 1823, pp. 984, dritter Band mit. 
sieben Kup. Goet. 1825, pp. 920 206 

XXIII. Anatomie Pathologique du Corps Humain, ou Descriptions avec 
Figures Lithographiees, des diverses Alterations Morbides dont le Corps 
Humain est susceptible. Par J. Cruveilhier, Professeur d' Anatomie a la 
Faculte de Medecine de Paris. Fol. Paris, 1828 - - - - 209 

XXIV. Address to the Community on the Necessity of Legalizing the 
study of Anatomy. By order of the Massachusetts Medical Society. Bos- 
ton, 1829, pp. 27 210^ 

XXV. The Anatomy, Physiology, and Diseases of the Teeth. By Thomas 
Bell, F. R. S., F. L. S., F. S. S., Member of the Royal College of Sur- 
geons in London, &c.; Lecturer on the Anatomy and Diseases of the 
Teeth at Guy's Hospital, and Surgeon-Dentist to that Institution. Carey 

& Lea, 1830. 8vo. pp. 351, plates XI 213 

XXVI. Atlas Historique et Bibliographique de la Medecine compose de 
Tableaux sur I'Histoire de 1' Anatomie, de I'Physiologie, de I'Hygiene, 
de la Medecine, de la Chirurgie et de I'Obstetrique, &c. Par Casimir 
Broussais, Docteur en Medecine, Chirurgien Aide-Major du Gymnase 
Normal Militaire et Civile, Professeur Agrege a la Faculte de Medecine 

de Paris, &c. &c. Paris, 1829. Folio, pp. 44 ... - - 214 



QUARTERLY PERISCOPE. 

FOREIGN INTELLIGENCE. 

AjS'ATOMT. 

Page. , Page. 

1. Congenital Absence of the Iris 2. Communication of theLympha- 

without loss of Vision. By M. tic Vessels with the Veins. By 

Behr - - - - - 215 Dr. Dubled - - - 216 



14 



CONTENTS. 



Physiology. 



Page. 
216 



3. Partial Loss of Memory 

4. On the Regeneration of Bone. 
By M. Flourens - - ih 

5. Instance in which Life was 
supported for a length of time 



Page. 

by the Absorption of the Fluids 
of the Body. By IVIr. Granger 217 
. Reciprocal Action of Gases 
through Animal Membrane. By 
Thomas Graham, Esq. - ib. 



Pathology. 



7. Wandering Paralysis with loss 

of Memory. By Dr. Duquesnell 217 

8. Loss of Sensation in one-half of 
the Body without Loss of the 
Power of Motion. By Dr. Le 
Sauvage - > - - 

9. Case in which Blood was found 
in the Lymphatics 

10. Case of Disease of the Lympha- 
tic System. By M. Amussat 

11. Case of Idiotism and Aphonia, 
produced by Fright, in a Wo- 
man at the Seventh Month of 
Pregnancy. By Madame Boivin 

12. Intermittent Aphonia. By M. 
Rennes . - - - 

13. Intermittent Aphonia of thirty 
years standing. By Dr. OUivier 

14. Case of Sudden Death from 
Obstruction of the Larynx. By 
Dr. Senn - - - - 

15. General Melanosis. By Profes- 
sor Lob stein 

16. Scirrhus of the Pylorus and 
Ulceration of the Stomach, with- 
out Pain on Pressure. By Mr. 
Waldron . - - - 

17. Case of Ascending Paralysis 



218 



219 



220 



ib. 



222 



ib. 



223 
ib. 



224 
226 



227 



228 



18. Case of Disease of the Pro- 
cessus Dentatus - - - 226 

19. Paralysis of the Muscles of 
one side of the Face from Dis- 
ease of the Portio Dura. By Mr. 
Abercrombie 

20. Organic Lesions produced by 
the Hydrocyanic Acid. By M. 
Orfila .... 

21. Mental Derangement from 
Gastric Irritation. By H. Wor- 
ship, Esq. - - - - ib. 

22. Hallucinations. By M. Bland 229 

23. Hullucination of Hearing. By 

M. Bland - - - - ib. 

24. Hallucination of Vision. By 

M. Bland - - - - 230 

25. Hallucination of Touch and 
Hearing. By M. Bland 

26. Affection of the Brain from a 
Fall, w^ith Retention of Urine. 
By Dr. John Abercrombie - 

27. Affection of the Brain with Re- 
tention of Urine, followed by 
Anasarca and Paralysis 

28. Softening of the Spinal Cord 

29. Cause and Treatment of Stut- 
tering. By Dr. Arnott 



ib. 



ib. 



231 
232 

233 



30. On the Action of Stramonium. 
By Dr. Amelung - - 235 

31. Properties of the Hydrocyanic 
SyruD of the French Codex. By 

M. Orfila ... - ib. 

32. On Vegeto-Alkaline Poisons, 



Matebia Medica. 

and the Neutralization of their 



Power. By M. Donne - 235 

33. Medicinal Properties of the 
Cainca. By MM. Pelletier and 
Caventou - - - 236 

34. One hundred and sixty grains 

of Camphor taken at a Dose ib. 



Pkactice of Medicixe. 



35. Tartar Emetic in large doses. 
By M. Laennec - - - 237 

26. Otorrhea in Children. By 
Dr. Amelung - . . ib. 

37. Oily Embrocations to the Ab- 
domen as a Remedy for Ascites. 
By Dr. Zavagli - - - ib. 



38. On the use of Stramonium in 
Mental Alienation, and some 
other diseases. By Dr. Amelung 237 

39. On the employment of Iodine 
in Lymphatic Tumours. Bv M. 
Bayle . . . '. 238 



CONTENTS. 



15 



Page. 

40. Treatment of Hooping Cough. 

By Dr. Kahleiss - - - 238 

41. Partial Palsy cured by Strych- 
nia applied Locally. By Dr. 
Auchincloss - - - 239 

42. Treatment of Persons Poison- 



Page. 
ed by Hydrocyanic Acid. By M. 
Orfila .... 239 

43. Sulphate of Saliclne a substi- 
tute for Quinine in the treat- 
ment of Intermittent Fevers. By 
M. Devilliers - - - 240 



Ophthalmology. 



44. Intermittent Ophthalmia re-' 
turning every seventh day. By 

Dr. Hueter ... 240 

45. Amaurosis completely cured 
by the Extraction of a Carious 
Tooth. By Dr. Galenzowski 241 



46. Cancer — Extirpation of the 
Eyeball. By John Couper, M. D. 241 

47. Pterygium cured by IPurga- 
tives. By Professor Rust - 242 



SURQEET. 



48. Case of Carotid Aneurism in 
which the Artery was taken up 
above the Tumour. By A. Mont- 
gomery, Esq. 

49. Treatment of Aneurisms by 
the Method of Valsalva. By M. 
Paillard .... 

50. Gastrotomy successfully per- 
formed. By Dr. Caroche - 

51. Prolapsus Ani treated accord- 
ing to the Method of Mr. Hey. 
By Dr. Macfarlane 

52. Treatment of Strangulated 
Hernia when the part is Gan- 
grenous. By M. Dupuytren 

53. Nsvus Maternus cured by Vac- 
cination. By Dr. Auchincloss 

54. Extirpation of the Uterus - 

55. Case of Strangulated Crural 
Hernia, reduced spontaneously 
after Gangrene of the Hernial 
Sac. By Dr. Girouard 

56. Fissure of the Anus success- 
fully treated without Incision or 
Cauterization. By M. Dupuy- 
tren 

57. Amputation of the Penis - 

58. Method of Removing Fibrous 
Polypi of the Uterus. By M. 
Dupuytren 

59. Treatment of Indolent Ulcer 
of the Leg. By J. Syme, Esq. 

60. On Operations Performed at 



242 



245 



ib. 



ih. 



246 

247 
ib. 



248 



ib. 
249 



ib. 



250 



the Solicitation of the Patient, 
against the judgment of the 
Surgeon. By M. Paillard - 251 

61. Case in which a Portion of 
Bone was lodged for Forty-eight 
days in the Trachea of an Infant. 
By Thomas Stabb, Esq. 

62. Wax as an Application to Ul- 
cers 

63. On the Utility of Water as an 
Apphcation in the Treatment of 
Wounds, Ulcers, Diseases of the 
Skin, &c. By John M'Fadzen, 
M. D. .... 

64. Tinea Capitis. By Dr. M'Fadzen 

65. Case of Fracture and Depres- 
sion of the Inner Table of the 
Cranium by a Musket Ball, the 
External Table being uninjured. 
By Dr. Hennen - 

66. Dislocation of the Clavicle 
forwards. — Reduction at the Ex- 
piration of Twelve Weeks. By 
Mr. Lyford 

67. Dislocation of the Head of the 
Radius backwards 

68. Vesico-Vaginal Fistula. By M. 
Dupuytren 

69. Hydrocele of the Spermatic 
Cord complicated with Perito- 
nitis, and Constipation of several 
days continuance. By Dr. Mac- 
lachlan - . . . 



ib. 



252 



253 



ih. 



254 



ib. 



Midwifery. 



70. Description of a Cicatrix of 
the Uterus, eight years after the 
Cxsarian Section had been per- 
formed. By Professor Mayer 257 



71. Procidentia Uteri. By J. J. 
Knox . . . - 



ih. 



257 



16 



CONTENTS. 



Medical JumsPBUDEJifCE, 



Page. 

72. Detection of Arsenic seven 
years after death. By M. Orfila 258 

73. Case of Vagitus Uterinus. By 
Dr. A. F. Holmes - - 259 

74. Poisoning' with Acetate of 
Copper . - - . ib. 



PaG£. 

75. Determination of the Period 
that a Drowned Body has been 
in the Water. By M. Alph. De- 
vergie - - - 260 



CHEMISTRf. 



76. Chemical Constitution of Ace- 
tic Ether. By M. Planiava - 261 

77. New Proximate Principle from 
Albumen. By M. Couerbe ib. 

78. Preparation of Urea. By M. 
Henry . . - - ib. 

79. Preparation of Hydriodic 



Ether. By M. Serullas 



262 



80. Means of Detecting Hydrocy- 
anic Acid. By M. Orfila - 262 

81. Analysis of Bile. By Henry 
Braconnot - - - - ib. 

82. Discovery of a New Principle 
in the Root of the Cainga. By 

M. Caventou - - _ ib. 



MlSCELLABiEOUS. 



83. Mortality of Paris - - 263 1 Classes of Society. By M. Du- 

84. Mortality in the Different meril - - - - - 264 

I 85. Vaccination. By Dr. Barres, Jr. ib. 



AMERICAN INTELLIGENCE. 



Case of Ozena cured by the use of 
Chloride of Lime. By WiUiam 
E. Horner, M. D. Adjunct Pro- 
fessor of Anatomy in the Uni- 
versity of Pennsylvania. 

New Bullet Forceps. By William 
Jones Madeira, of Chambers- 
burg, Pa. - - - - 

Fracture of the Coronoid Process 
of the Ulna. By WilUam M. Fah- 
nestock, M. D. - 

Fracture of the Condyles of the 
Os Humeri. By William M. 
Fahnestock, M. D. 

On Dengue. By William R. War- 
ing, M. D. of Savannah 

Philadelphia Medical Society 

Charge Addressed to the Gradu- 
ates in Medicine, at the Com- 



265 



266 



267 



ib. 

ib. 

274 



mencement of the Medical De- 
partment of the Columbian Col- 
lege, D. C. Bv Thomas P. Jones, 
M. D. . ' . . . 

Coxe's American Dispensatory 

Horner's General and Special Ana- 
tomy - - - . 

MaccuUoch on Remittent and In- 
termittent Diseases 

Memoir on the Treatment of Ve- 
nereal Diseases without Mercu- 
ry, employed at Val-de-Grace. 
By H. M. J. Desruelles 

Hennen's Military Surgery 

Necrology. 

John D. Godman, M. D. - 
Stephen Elliott, Esq. 
Josiah Goodhue, M. D. 



274 
ib. 

ib. 

ib. 



ib. 

ib. 

ib, 

275 

ib. 



THE 



AMERICAN JOURNAL 



OF THE 



MEDICAL SCIENCES. 



No. XII.— August, 1830. 26 



COLLABORATORS. 



Jacob Bigelow, M. D. Professor of 
Materia Medica in Harvard Univer- 
sityy Boston. 

Edward H. Baktox, M. D. of St. 
Francisvilkf Louisiana. 

Walter Channikg, M. D. Professor of 
Midwifery and Legal Medicine in 
Harvard University, Boston. 

N. Chapman, M. D. Professor of the 
Institutes and Practice of Physic and 
Clinical Practice in the University of 
Pennsylvania. 

John Redman Coxe, M. D. Professor 
of Materia Medica and Pharmacy in 
the University of Pennsylvania. 

WiitiAM C. Daniell, M. D. of Savan- 
nah, Georgia, 

E. De Butts, M. D. Professor of Che- 
mistry in the University of Mary- 
land. 

"William P. Dewees, M. D. Adjunct 
Professor of Midwifery in the Univer- 
sity of Pennsylvania. 

S. Henry Dickson, M. D. Professor of 
the Institutes and Practice of Medicine 
in the Medical College of South Caro- 
lina. 

Benjamin W. Dudley, M. D. Profes- 
sor of Anatomy and Surgery in Tran- 
sylvania University. 

GouvERNEun Emerson, M. D. of Phila- 
delphia. 

Thomas Fearn, M. D. of Alabama. 

John W. Francis, M. D. Professor 
of Obstetrics and Forensic Medicine 
in Bulgers Medical College, New 
York. 

E. Geddings, M. D. Lecturer on Anato- 
my and Surgery, Charleston, South 
Carolina. 

William Gibson, M. D. Professor of 
Surgery in the University of Pennsyl- 
vania. 

R. E. Griffith, M. D. of Philadelphia. 

E. Hale, M. D. of Boston. 

Robert Hare, M. D. Professor of Che- 
mistry in the University of Pennsyl- 
vania. 

Isaac Hays, M. D. one of the Surgeons 
of the Pennsylvania Infirmary for 
diseases of the Eye and Ear. 
George Haywabd, M. D. of Boston. 



Thomas Henderson, M. D. Professor 
of the Theory and Practice of Medi- 
cine in the Columbian College, l)is^ 
trict of Columbia, 

William E. Horner, M. D. Adjunct 
Professor of Anatomy in the Univer- 
sity of Pennsylvania. 

David Hosack, M. D. Professor of the 
Institutes and Practice of Medicine in 
Bulgers Medical College, New York. 

Ansel W. Ives, M. D. of New York, 

Samuel Jackson, M. D. Assistant to the 
Professor of the Institutes and Practice 
of Medicine and Clinical Practice in 
the University of Pennsylvania. 

Samuel Jackson, M. D. of Northum- 
berland, Pennsylvania, 

W. J. Macneven, M. D. Professor of 
Therapeutics and Materia Medica in 
Butgers Medical College, New York. 

C. B. Matthews, M. D, of Philadelphia. 

Valentine Mott, M. D. Professor of 
Surgery in Butgers Medical College, 
New York. 

James Moultrie, Jr. M. D. of Charles- 
ton, S. C. 

Reuben D. Mussey, M. D. Professor 
of Anatomy and Surgery in Bart- 
mouth College, New Hampshire. 

James M. Pendleton, M. D. Lecturer 
on Midwifery and Diseases of Women 
and Children, New York. 

Philip Syng Phystck, M. D. Profes- 
sor of Anatomy in the University of 
Pennsylvania. 

Nathaniel Potter, M. D. Professor of 
the Theory and Practice of Medicine 
in the University of Maryland 

Thomas Sewall, M. D. Professor of 
Anatomy and Physiology in the Co- 
lumbian College, Districi of Columbia. 

John Ware, M. D. of Boston. 

John C. AVarren, M. D. Professor of 
Anatomy and Surgery in Harvard 
University, Boston. 

J. Webster, M. D. Lecturer on Ana- 
tomy and Surgery, Philadelphia, 

N. W. WoRTHiNGTON, M. D. ProfcssoT 
of Materia Medica in the Columbian 
College, District of Columbia. 

Thomas H. Wright, M. D. Physidanio 
the Baltimore Aims-House Infirmary. 



TO READERS AND CORRESPONDENTS, 



Some interesting' communications will be found under the head of American 
Intellig-ence. Nearly all the articles in this department are original. 

The following publications have been received: — 

Traite des Maladies des Voies Urinaires. Par Chopart, Professeur, &c. Nou- 
velle edition, Revue, Corregee, Augmentee de Notes et d'un Memoire sur les 
Pierres de la Vessie et sur la Lithotomie. Par M. E. H. Felix Pascal, D. M. P. 
&c. &c. 2 vols. 8vo. Paris, Germer BailUere, 1830. 

La Manoeuvre de tous les Accouchemens Contre Nature, Reduite a sa plus 
Grande Simplicite etprecedee du Mechanisme de 1' Accouchement Naturel, Par 
Jules HATiiir, D. M. P. &c. Paris, Germer Bailliere, 1827. 

Circulation du Sang dans le Foetus, Decrite et Dessignee, par J. Achille 
CoMTE, Interne des Hopitaux Civils, &c. Paris, Germer Bailliere, 1827. 

Cours de Philosophie Positive. Par M. Auguste Comte, Ancien Eleve de 
I'Ecole Potucnique. 1 Livraison. Paris, Rouen Freres, 1830. 

Memoires sur I'Electro-Puncture, consideree comme Moyen Nouveau de 
Traiter Efficacement la Goutte, les Rheumatismes et les Affections Nerveuses, 
et sur I'Emploi du Moxa Japonia en France; suivis d'un Traite de 1' Acupunc- 
ture et du Moxa, Principaux Moyens Curatifs ches les Peuples de la Chine, de 
la Coree, et du Japon; ornes de Figures Japonaises, par le Chevalier Sarlak- 
IDIERE, D. M. Paris, Melle. Delauney, 1825. 

Transactions of the Medical and Physical Society of Calcutta, Vols. I. and II. 
(From the Society.) 

Traite des Plaies de Tete et de I'Encephalite Principalement de celle qui 
leur est Consecutive: Oiivrage dans lequel sont Discutees Plusieurs Questions 
relative aux Fonctions du Systeme Nerveux en General. Par J. P. Gama, D.M. 
Chirurgien en Chef Premier Professeur a I'Hopital Militaire d'Instruction du 
Val-de-Grace a Paris. Sedillot, Paris, 1830. 

Traite General d'Anatomie Comparee. Par J. F. Meckel. Traduit de I'Al- 
lemand et Augmente de Notes. Par MM. Riester et Alph. Sanson, Docteurs 
en Chirurgie de la Faculte de Paris, Tom. VI. Rouen Freres. 

Memoires Composes au sujet d'une Correspondance Meteorologie, ayant 
pour but de Parvenir a Predire le temps beaucoup a I'Avance sur un point 
donne de la Terre. Par P. E. Morin, Ancien Eleve de I'Ecole Polytecnique. 
&c. Memoire 1, 2, 3, 4. Paris, 1827-9. 

Traite Elementaire d'Anatomie contenant les Preparations 1' Anatomic De- 
scriptive et les Principales Regions du Corps Humain. Par A. Brierre be 
BoiSMOKT, D. M. P. 8cc. Avec des Notes Extraites du Cours de Ph. Fred. 
Blandin, Professor Particulier d'Anatomie et de Medecine Operatoire, &c. Pa- 
ris, Mme. Auger Mequinon, 1827. 

Observations on the Endermic Application of Medicines. By Willtam W, 
Gerhard, M. D. (From the author.) 



292 TO READERS AND CORRESPONDENTS. 

Journal der Chirurg-ie und Augen-Heilkunde, herausgegeben von C. F. r. 
Graefe und Ph. v. Walthee. (In exchange.) 

Litterarische Annalen der gesammten Heilkunde, September, October, No- 
vember, December, 1829, and January, February, March, 1830. (In exchange.) 

Archives Generales de Medecine; Journal publiee par una Societe de Mede- 
cins. January, February, March, April, 1830. (In exchange.) 

Bulletin des Sciences Medicales, redige par M. Defeemon. January, Fe- 
bruary, 1830. (In exchange.) 

Revue Medicale, Francais et Etrangere, Journal de Clinique de I'Hotel- 
Dieu, de la Charite, et des Grands Hopitaux de Paris? et Nouvelle Bibliotheque 
Medicale. February, March, 1830. (In exchange. ) 

Annales de la Medecine Physiologique. February, March, 1830. (In ex- 
change.) 

Journal General de Medecine, de Chirurgie, et de Pharmacia Fran5aises et 
Etrangeres. March, April, May, 1830. (In exchange.) 

La Clinique, annales de Medecine Universelle, Vol. II. Nos. 23 to 39 inclu- 
sive. (In exchange.) 

Journal de Chimie Medicale, de Pharmacia et de Toxicologic. January, Fe- 
bruary, March, April, May, 1830. (In exchange.) 

Journal Universel des Sciences Medicales. February, March, 1830. (in ex- 
change.) 

Memorial des Hopitaux du Midi, et de la Clinique de Montpelier. Par le 
,Prof. Delpech. February, March, 1830. (In exchange.) 

The Medico-Chirurgical Review and Journal of Practical Medicine, for April, 
1830. (In exchange.) 

The London Medical Gazette, for March, April, and May, 1830. (In ex- 
change.) 

The Edinburgh MedlcalandSurgical Journal, for April, 1830. (In exchange.) 

The London Medical and Physical Journal, for March and April. (In ex- 
change.) / 

London Medical and Surgical Journal, for March and April, 1830. (In ex- 
change.) 

The North American Medical and Surgical Journal, July, 1830. (In exchange.) 

The New York Medical and Physical Journal, for January, 1830. (In ex- 
change.) 

The Baltimore Monthly Journal of Medicine and Surgery, Vol. I. Nos. 1, 2, 
3, 4. (In exchange.) 

The Boston Medical and Surgical Journal, Vol. III. Nos. 12 to 22 inclusive. 
(In exchange.) 

The Western Journal of the Medical and Physical Sciences, April, 1830. 
(In exchange.) 

The Maryland Medical Recorder, for January, April, and July, 1830. (In 
exchange.) 

For the gratification of our contributors we continue the references to the 
works, in which they will find notices to their communications; these references 



TO READERS AND CORRESPONDENTS. 293 

are, of course, restricted to the Journals received during the preceding three 
months. 

Professor Chapmak will find his paper on Haemorrhage noticed in Froriep's 
Notizen, for August, 1829. 

Professor Mott's case of Aneurism of the Innominata is noticed in the Lon- 
don Medical Gazette, for April? in the Archives Generales, for April; Baltimore 
Monthly Journal of Medicine and Surgery, for February, 1830; Maryland Me- 
dical Recorder, No. 3; and his case of Extirpation of an Osteo-sarcomatous 
Clavicle in the Bulletin des Sciences Medicales, for September, 1822. 

Professor Dewees will find his paper on Secale Cornutum noticed in the 
Transactions of the Medico-Chirurgical Society of Edinburgh, Vol. III. Pt. II. 

Professor Musset will find his case of Aneurism by Anastomosis noticed in 
the Archives Generales, for April; in the London Medical Gazette, for April; 
in the Baltimore Monthly Journal, for February; and in the Baltimore Medical 
Recorder, No. 3; and his Experiments upon the Colouring of Foetal Bones with 
Madder, noticed in the Revue Medicale, for February, and the Archives Gene- 
rales for March. 

Professor Dicksok's Observations on the Effects of Heat are noticed in Fro- 
riep's Notizen for July, 1829. 

Professor Sewall's remarks on the Use of Turpentine in Hernia, are copied 
in the London Medical and Physical Journal, for March, and in the Maryland 
Medical Recorder, No. 2. 

Professor Jackson's observations on Absorption are noticed in the Baltimore 
Monthly Journal, for February; his remarks on the Pulse are noticed in the 
Boston Medical and Surgical Journal for June, and his case of Croup in the 
Maryland Medical Recorder, No. 2. 

Professor Horner's cases of Cholera Infantum are noticed in Froriep's Noti- 
zen, for June, 1829. 

Dr. Wright's observations on the Use of the Warm Bath in Delirium Tre- 
mens are noticed in the Boston Medical and Surgical Journal, for May, and in 
the North American Medical and Surgical Journal, for July; his Hospital Re- 
ports are noticed in the Baltimore Monthly Journal, for February. 

Dr. SiMONs's remarks on the Use of Pyroligneous Acid are noticed in the 
London Medical Gazette, for May; in the New York Medical and Physical Jour- 
nal, for January; in the Baltimore Monthly Journal, for February; in the North 
American Medical and Surgical Journal, for July; and in the Maryland Medi- 
cal Recorder, for July, 1830. 

Dr. Henderson's case of Disease of the Bones is copied in the Archives G6- 
n^rales, for March, 1830. 

Dr. Lehman's paper on Otitis is noticed into the London Medical and Phy- 
sical Journal, for April. 

Dr. Jackson's case of Supposed Poisoning is analyzed in the North American 
Medical and Surgical Journal, for July. 

Dr. Hetjstis's case of Gun-shot Wound is republished in the Maryand Me- 
dical Recorder, No. 2. 

26* 



294 TO READERS AND CORRESPONDENTS. 

Dr. Hat ward's case of Paruria Inops is copied in the Maryland Medical Re- ' 
corder. No. 2. 

Dr. Giiiian's case of Excision of the Cervix Uteri, is noticed in the Baltimore 
Monthly Journal, for February. 

Dr. Bxune's paper on the Use of Tartar Emetic Ointment is noticed in the 
Baltimore Monthly Journal, for February. 

Dr. FAHjfESTocK's case of Concealed Phthisis is noticed in the Baltimore 
Monthly Journal, for February; his observations on the Use of Rhus Glabrum 
are copied in the Revue Medicale, for February; and his paper on the Use of Da- , 
tura Stramonium is copied in the London Medical and Physical Journal, for April. 

Dr. Randolph's case of Osteo-Sarcoma of the Lower Jaw is copied in the 
London Medical Gazette, for April, 1830. 

Dr. Wells's case of Elephantiasis of the Scrotum is noticed in Titley's work 
on Diseases of the Male Genitals. 

Dr. Gaylord's case of Intus-susception is noticed in the London Medical Ga- 
zette, for May, 1830. 

Dr. Hall's case of Wound of the Rectum and Bladder is noticed in the Lon- 
don Medical and Physical Journal, for April. 

Dr. Taliaferro's case of Paralysis cured by Moxas, is copied in the Boston 
Medical and Surgical Journal, for July, 1830. 

Dr. Faust's Essay on Malaria is noticed in the Boston Medical and Surgical 
Journal, for May, 1830. 

Dr. Levert's Experiments on the Use of Metallic Ligatures are noticed in 
the Revue Medicale, for February, 1830, and in the Bulletin des Sciences Me- 
dicales, for September, 1829. 

Dr. Guild's case of Epilepsy is noticed in the Medico-Chirurgical Review, 
for April, 1830. 

Dr. Peirce's case of Perforation of the Stomach is republished in the London 
Medical and Physical Journal, for March, 1830. 

Dr. Pennock's Experiments on Cupping-Glasses in Poisoned Wounds are 
noticed in the Annales des Sciences d'Observation, for April, 1829. 

Dr. RoDRiGUEs' Experiments on Ligatures in Poisoned Wounds are noticed 
in the Annales des Sciences d'Observation, for April, 1829. 

We are compelled, by want of room, to postpone other references until our 
next number. 

Authors of new medical books, desirous of having them reviewed or noticed 
in this Journal at the earliest opportunity, are invited to transmit to the Editor ' 
a copy as soon after publication as convenient, when they will receive prompt 
attention. Under ordinary circumstances, very considerable delay is caused by 
the circuitous routes through which they are received. 

Papers intended for publication, should be sent, free of expense, as early after 
the appearance of the Journal as possible, in order to be in time for the ensuing 
number. Such communications should be addressed to *' Caret & Lea, Phila- 
delphia, for the Editor of the American Journal of the Medical Sciences." All let- 
ters on the business of the Journal to be addressed exclusively to the publishers. 



CONTENTS 



ORIGINAL COMMUNICATIONS. 
ESSAYS. 

Aut. Page, 

I. Case of Fungus Hsematodes. By Thomas Sewall, M. D. Professor of 
Anatomy and Physiology in the Columbian College, District of Colum- 
bia. [With a plate] SOI 

II. On the Use of the Warm Bath in Season Fever, commonly called 
" Bilious," ** Bilious Typhus," &c. &c. By Thomas H. Wright, M. D. 
Physician to the Baltimore Alms-house Infirmary . - - - 303 

III. Case of Elephantiasis of the Scrotum successfully extirpated. By W. 
H. Ruan, M. D. of St. Croix. (Communicated in a letter to John Ruan, 
M.D. of Philadelphia) - - 311 

IV. On Rhubarb in Haemorrhoids. By Samuel Jackson, M. D. of Northum- 
berland 315 

V. Observations on Mania a Potu. By Jesse Carter, M. D. one of the 
Resident Physicians of the Philadelphia Alms-house Infirmary - 321 

VI. Account of a Case of Trismatic Tetanus, produced by the Passage of 
large, rough, and angular pieces of Clay from the Intestinal Canal into 
the Vagina, and cured by Tobacco Injections. By Burleigh Smart, M. 
D. of Kennebunk, Maine. Read before the Medical Society of Maine, 

at its Semi-annual Meeting at Portland, in January, 1825 - - 337 

VII. Observations on the Medical Topography of Callao, with an Account 
of Disease of the Liver, as it appeared on board of the United States' 
Frigate Brandywine, during a Cruise in the Pacific Ocean, in the years 
1826-7-8-9. By W. S. W. Ruschenberger, M. D. of Philadelphia, As- 
sistant Surgeon U. S. N 342 

VIII. Extirpation of a Cancerous Eye. By Harvey Lindsly, M. D. of Wash- 
ington, I). C. .349 

IX. Case of Rupture of the Uterus, successfully treated. By William S. 
Hendrie, M. D. of Hilltown, Penn. 351 

X. Meteorological Observations, made in the City of Philadelphia, lati- 
tude 39° 57\ and on the Island of Tinicum, eleven miles south-west from 
Philadelphia, latitude 59° 48', for the year 1827. By George F. Leh- 
man, M. D. Lazaretto Physician of the Port of Philadelphia. (Continued 
from No. XI. page 138) 353 

XI. On the Pathological or Abnormal State of the Circulation. By Samuel 
Jackson, M. D. Assistant to the Professor of the Institutes and Practice 

of Medicine and Clinical Practice in the University of Pennsylvania 364 

XII. Remarks on the Climate and Diseases of Batavia, and on the Means of 
guarding against them. By George S. Bettner, M. D. of North Carolina 380 



296 CONTENTS. 

XIII. Case of Perforation of the Stomach by Ulceration. By Dr. Levi 
Rawson, of Grafton, Mass 391 

REVIEWS. 

XIV. Memoir on the Treatment of Venereal Diseases without Mercury, 
employed at the Military Hospital of the Val-de-Grace. Translated from 
the French of H. M. J. Desruelles, M. D. &c. &c. To which are added. 
Observations on the Treatment of the Venereal Disease without Mer- 
cury. By G. J. Guthrie, Esq. Deputy Inspector of Hospitals, Lecturer 
on Surgery, &c. And Various Documents showing" the results of this 
Mode of Treatment in Great Britain, France, Germany, and America. 
Philadelphia, Carey & Lea, 1830, pp. 217, 8vo. 

Observations on the Pathology of Venereal Affections. By Benjamin Tra- 
vers, F. R. S. and Senior Surgeon to St. Thomas's Hospital. London, 
1830, pp. 75, Svo. 394 

XV. Me moire sur I'Emploi de I'lode dans les Maladies Scrofuleuses, lu a 
I'Ac^demie Royale des Sciences, dans la seance du 22 Juin, 1829. Par 
J. G. A. Lugol, Medecin de I'Hopital Saint-Louis; Precede du Rapport 
fait a 1' Academic. Par MM. Serres, Magendie et Dumeril, Paris, 1829, 
pp. 78, 8vo. 

Memoire sur I'Emploi des lodures dans les Maladies Scrofuleuses; suivi 
d'un Tableau pour servir a I'Administration des Bains lodures selon les 
ages. Par J. G. A. Lugol, Medecin de I'Hopital Saint-Louis. Paris, 
1830. pp. 52, 8vo. 408 

XVI. Les Medecins Frangais Contemporains, Par J. L. H. P***. Paris, 
1827, pp. 112, 8vo 418 

XVII. Lehrbuch der Gynakologie, oder systematische Darstellung der 
Lehren von Erkenntniss und Behaiidlung Eigenthiimlicher Gesunder 
und Krankhafter Zustande, Sowohl der nicht Schwangern, Schwangern 
und Gebarenden Frauen, als der Wochnerinnen und Neugebornen Kin- 
der. Zur Grundlage Akademischer Vorlesungen, und zum Gebrauche 
fiir Praktische Aerzte, Wundarzte und Geburtshelfer, Ausgearbeitet. 
Von Carl. Gustav. Carus, Dr. der Philosophic, Medicin und Chirurgie, 
8cc. &c. Zweiter Theil, pp. 608. Leipzig, 1828. 

Compendium of Gynsecology, &c. By C. G. Carus, Doctor of Philosophy, 
Medicine and Surgery, &.c. Part second. Leipzig, 1828. - - 429 

BIBLIOGRAPHICAL NOTICES. 

XVIII. Die Krankheiten des Gehoerorganes. Ein Handbuch zum Ge- 
brauche seiner Vorlesungen. Von Karl Joseph Beck, der Arzneiwissen- 
schaft Doctor, Ordentlichen Professor an der hohen Schule in Freiburg, 
und mehrerer Gelehrten Gesellschaften Mitgleide. Heidelberg und 
Leipzig, 1827. 

Manual of Diseases of the Ear, &c. By Karl Jos. Beck, Doctor of Sur- 
gery, &c. 1827 459 

XIX. Traite des Maladies des Voies Urinaires. Par Chopart, Professeur 
auxEcoles de Chirurgie, Chirurgien en Chef de I'Hospice du College de 
Chirurgie de Paris, etc. Nouvelle edition, revue, corrig^e, augment^e 



CONTENTS. 297 

Pa&e. 

de notes et d'lin Memoire sur les Pierres de la vessle et sur la Lithoto- 
mie? Par M. E. H. Felix-Pascal, Docteur en Medecin de la Faculte de 
Paris, etc. Vols. 2. Oct. pp. 948. Paris, 1830 - - - - 461 

XX. Handbuch der Anatomie des Menschlichen Kbrpers mit Abbildungen. 
Von Martin Miinz, Doct. der Medizin und Chirurgie, bey der ausUben- 
dem Arzte, dffentlichem ordentlichen Professor der Anatomie und Phy- 
siologic an der Ludwig-s-Maximilians-Universitat zu Landshut, &c. 
Erster Theil, Muskellehre, Landshut, 1821. Zvveyter Theil, Gefass- 
lehre, 1821. Dritter Theil, Eing-eweiddehre, 1827 - - - 463 

XXI. Institutionum Medicinae Practicse, quas auditoribus suis prselegebat. 
Jo. Bapt. Burserius, de Kanifeld, Recudi curavit, Just. Frid. Car. Hecker, 
Medicinsc, Utriusque Doctor, et Professor P. E. in Univers. Litter. Beroli- 
nensi, plurium Societatum Medicarum, et Litterar. Socialis. Vol. 4. 
Lipsix, 1826. 

The Institutes of the Practice of Medicine, of Jo. Bapt. Burserius. Edit- 
ed by Professor Hecker, of Berlin, &c. 4 vols. Leipsic, 1826 - - 468 

XXII. Medico-Chirurgical Transactions. Published by the Medical and 
Chirurgical Society of London. Vol. XV. Pt. II. London, 1830, pp. 
187, 8vo. Plates 4 469 

XXIII. Handbuch der Entbindungskunst. Von Dr. Friedrich Benjamin 
Osiander, Wieland Konigl. Grossbrit. Ilanov. Hofrath, und Professor der 
Medicin und Entbindungskunst, Director des K. Entbindungs Hospitals, 
Mitglied der K. Societat der Wissenschaften zu Gbttingen, &c. Erster 
band. Zwelte Vermehrte Auflage. Eearbeitet von Dr, Johann Friedrich 
Osiander, Prof, der Medicin zu Gbttingen, &c. mit dem Portrait des 
Verfassers. TUbengen, 1829. 

Manual of Midwifery. By Fred. Benj. Osiander, M. D. Second improv- . 
ed edition, edited by John F. Osiander, M. D. Professor of Medicine at 
Gottingen, &c. 475 

XXIV. A Treatise on Deformities; exhibiting a Concise view of the Nature 
and Treatment of the principal distortions and contractions of the limbs, 
joints, and spine. Illustrated with i)lates and wood cuts. By Lionel J. 
Beale, Surgeon. London, 1830, pp. 248. PI. 4 - • - - 476 

XXV. Memoires sur I'Electro-Puncture, consideree comme moyen Nou- 
veau de Traiter efRcacement la Goutte, les Rheumatismes, et les Affec- 
tions Nerveuses, et surl'emploi du Moxa Japonia en France; Suivisd'un 
Traite de I'Acupuncture et du Moxa, principaux Moyens Curatifs chez 
les peuples de la Chine, de la Coree et du Japon; Ornes de figures 
Japonaises. Par Le Chevalier Sarlandiere, Docteur en Medecine, 
Membra de Plusieurs Academies et Societes Savantes. Oct. pp. 150. 

PI. 2. A Paris, 1825 477 

XXVI. Traite Elementaire d' Anatomie, contenant les Preparations, I'Ana- 
tomie Descriptive et les Principales regions du corps humain. Par A. 
Brierre de Boismont, D. M. P. &c. &c. Avec des notes Extraites du 
cours de Ph. Fred. Blandin. Professor particulier d' Anatomie et de 
Medecine operatoire, &c. &c. Paris, 1827, pp. 800, Svo. - - 479 



298 



CONTENTS. 



QUARTERLY PERISCOPE, 

FOREIGN INTELLIGENCE. 

AjfATOMT. 



Page. 

1. Singular Case of Malformed 
Heart. By Edward Blackmore, 

M. D. - - - . - 480 

2. Anomalies in the Distribution 
ofsome of the Veins. By Meckel 482 



Page, 

3. Case of United Twins - 483 

4. Malformation of the Heart. By 
Professor Dug-es - - ib. 



Physiosogt. 



5. Experiments upon the Colour- 
ing' of Different Tissues. By M. 
Casimir Broussais 

6. Very Remarkable Case of 
Twins. By Dr. Meza 

7. Researches on Pulmonary Ab- 
sorption and Exhalation. By 

M. Collard de Martig-ny - 485 

8. Experimental Researches on 



483 



484 



the Gaseous Exhalation from 
the Skin. By M. Collard de 
Martigny - - - , 485 

9. On Vaccine Virus. By Dr. Ro- 
bert - - - . . 

10. Small-pox occurring twice in 
the same Individual. By Dr. 
Oppert - - . . 



ib. 



iK 



PATHOLOGT. 



11. On the Morbid Anatomy of 
Fever. By Alexander J. Han- 
nay, M. D. - . - 485 

12. Hernia of the Stomach, with 
Enormous Enlargement of that 
Organ. By M. Yvan - - 492 

13. On Crepitating Rattle. By M. 
Guesne . . . . H. 

14. Poisoning by Cantharides in 
Powder, followed by the Expul- 
sion of the Mucous Membrane 
of the (Esophagus. By M. Rou- 
quairol ... - 493 



15. Meningitis and Abscess in the 
Left Corpus Striatum - 493 

16. Case of Otitis, with discharge, 
terminating in the formation of 
Abscesses within the Head 494 

17. Case of Uterine Phlebitis, 
with Inflammation of the Sub- 
stance of the Uterus, and Pus 
in the Absorbents. By Caesar 
Hawkins, Esq. ... 495 

18. Phlegmasia Dolens in a Male. 

By A. Copland Hutchison - ih, 

19. On Deng-ue. By Dr. Mellis ib. 



Matemia Medica. 



20. On the Morbid Phenomena 
caused by the Use of Iodine. 

By Dr. Jahn - - - 496 

21. New Mode of Preparing Me- 
dicines with Sugar. ByM. Beral 497 

22. Formulae for Preparations of 
Sarsaparilla. By M. Beral - ib. 

23. On Balsam of Copaiba. ByM. 
Gerber .... 499 



ByM. 



24. On Gum Ammoniac. 
Szowits - - - 499 

25. On the Taste of Sulphate of 
Quinine. By Schweinsberg ib. 

26. On Phosphate of Quinine. By 
Dr. Harless - - . ib^ 

27. On Mudar. By Bamboo Ram 
Cornel .... 500 



Practice of Medicine. 



28. On the Use of Iodine in Mor- 
bid Growths. By B. Brodie, 
Esq. 500 

29. Nitre as a Remedy for Scurvy. 

By Mr. Charles Cameron - 501 



30. Case of Ileus cured by Crude 
Mercury. By Dr. Ebers - 502 

31. Treatment of Extensive 
Burns. By Dr. Dorfmuller 503 

32. Frontal Neuralgia cured with 



CONTENTS, 



299 



Page. 
Extract of Belladonna. By M. 
Claret ... - 503 

33. Case of Paralysis of the Face. 

By M. H. Montault - - ib. 

34. Ascites cured by the External 
Apphcation of Digitalis. By 

M. Raisin - - - - ib. 



Page. 
35. On Head-ache. By M. Rlcord 503 



36. Ergot of Rye as a Febrifuge. 
By Dr. Mehlhausen - 

37. Clinical Reports of the Effects 
of Venesection in the Cold 
stage of Intermittent Fever. By 
Mr. Twining - - - 



Ophthai-moiogt. 



38. On the Treatment of certain 
Injuries of the Eyes. By Samuel 
Barton . ... 504 

39. On Amaurosis. By M. Du- 
puytren - . - - 506 

40. Evacuation of the Humours 
of the Eye by a Wound, with 
Restoration of Sight. By Baron 
Larrey - - - - ib. 



41. On the Use of the Essential 
Oil of Lemons in some of the 
Diseases of the Eyes. By M. 
Werlitz .... 

42. On the Employment of Ice in 
the Ophthalmia of New-born 
Children. By M. Rust 



Surgery. 



43. Case of Tetanus caused by a 
Foreign body imbedded in the 
Ulnar Nerve. By M. Dupuy- 
tren 508 

44. Opinion of the Comparative 
Advantages of Union by the 
First and Second Intention af- 
ter Amputation. By M. Dupuy- 
tren ib. 

45. Excision of the Neck of the 
Uterus. By M. Richard - 509 

46. Case of Injury of both Hemi- 
spheres of the Brain. By Henry 
Maunsell, Esq. - - - ib. 

47. Treatment of Hernia Humo- 
ralis. By M. Dupuytren - 510 

48. Sequel of '* A Case of Caro- 
tid Aneurism, where the Artery 
was taken up above the Tu- 
mour." By Alexander Montgo- 
mery - - - - 511 

49. Excision of the Elbow-Joint. 

By Mr. Syme - - - ib. 

50. Excision of the Knee-joint. 

By Mr. Syme - - - 512 

51. Excision of the Upper Jaw. 

By John Lizars, Esq. - 513 



52. Tapping in Hydrocephalus. 
By Dr. Conquest 

53. Amputation of the Arm at the 
Shoulder Joint. By Baron Lar- 
rey 

54. Real Bronchocele. By Baron 
Larrey . . - - 

55. Extirpation of a Scirrhous Tu- 
mour. By Baron Larrey 

56. Tracheotomy. By Baron Du- 
puytren - - . . 

57. Case in which a Foreign Body 
remained ten years in the Bron- 
chia before causing death. By 
M. Dupuytren - 

58. Case of Polypus Tumour ob- 
structing the Glottis and caus- 
ing Death. By M. Dupuytren 

59. Case of Recovery from a 
Wound in the Stomach inflict- 
ed by a Pistol Ball. By P. Bre- 
ton, Esq. .... 

60. Inveterate Herpes cured by 
Extirpation. By Dr. Eberl 

61. Disease of the Maxillary Si- 
nus. By John Couper, M, D. 

62. Laceration of the Kidney. By 
John Couper, M. D. - 



ib. 



504 



507 



ib. 



514 



515 



516 



ib. 
517 



518 



ib. 



519 



ib. 



520 



Midwifery. 

63. Csesarean Operation on a Pa- 
tient dead from Haemoptysis. 
By M. Hugueir - . - 521 

'64. Detachment of the Placenta 
by the Injection of Acidulated 



Water into the Umbilical Cord. 
By Dr. Chiesa ... 521 
65. Retroflection of the Uterus. 
By J. M. Baynham, Esq. - ib. 



300 



CONTENTS. 



Medical JuRrspauDENCE. 
Page 



66. Case of Poisoning- with Arse- 
nic. By Eobert Christison, 
M. D. . . - . 523 



Vag%, 

67. Case of Poisoning- by Arsenic. 
By Hugh Wood, M. D. - 524 



Chemistry. 

68. On the Influence of Electri- 
city on Animal Putrefaction. 
By Charles Matteucci - 525 



By M. 



69. Analysis of Copaiba. 
Gerber - . . . 

70. On the Purity of Balsam Co- 
paiba. By M. Gerber 



526 
ib. 



Miscellaneous. 



71. Obstetrical Statistics of the 
Kingdom of Wiirtemberg. By 
Dr. Riecke - - - 526 



72. Statistics of the Netherlands. 

By M. Quetelet - - 528 

73. Vaccination - - - 530 

74. On Plague. By Dr. Madden 531 



AMERICAN INTELLIGENCE. 



Second Report of Professor Mott's 
Case of Aneurism, treated by 
Tying the Artery Ultra Tumo- 
rem 532 

Extract from the Report of a Com- 
mittee upon the Subject of Os- 
teo-Sarcoma of the Lower Jaw, 
to a Medical Society of New 
York, April 1st, 1830. By Da- 
vid L. Rogers, M. D. Chairman 533 

Case of Uterine Haemorrhage, re- 
sulting from an Attachment of 
the Placenta over the Os Uteri, 
in a Second Pregnancy. By W. 
C.Roberts, Student of Medicine 534 

Compound Tincture of Benzoin 
as a Remedy for Scalds and 
Burns. By William M. Fahne- 
stock, M. D. - - - 538 

Case of Bloody Infiltration into 
the Labia Pudendi. By Wil- 
liam S. Hendrie, M. D. of Hill- 
town, Penn. (Communicated 
in a letter to Dr. Dewees) ib. 

Cases of Fracture of the Liver. 
By John O. Green, M. D. of 
Lowell, Mass. - - - 539 

Case of Poisoning with Corrosive 
Sublimate, in which the Admi- 
nistration of Charcoal afforded 



great relief. By William P. 
Hort, M. D. of Bladen county, 
North Carolina - - - 

Case of Scrofula successfully 
treated with Iodine. By Charles 
Lee Payne, M. D. of Lexing- 
ton, N. C. - 

Case of Disease of the Heart, with 
Rupture of the Right Auricle. 
By Philander H. Thomas, M. D. 
of Hancock, Mass. 

Arsenic in Large Doses. By R. 
Dakin, M. D. of Columbus, N. J. 

Account of a Man who Lived on 
Water for Fifty-four days. By 
James M*Naughton, M. D. Pro- 
fessor of Anatomy and Physio- 
logy in the University of the 
State of New York - 

Endermic Medication. By Dr. 
William W. Gerhard 

Perturbatlng Treatment. 

Case of Imperforate Hymen. By 
Dr. J. W. Horton 

Prize Essay - - - . 

Return of Deaths within the City 
of Charleston, from the 1st of 
January, 1829, to the 1st of Ja- 
nuary, 1830 ... 546 

Index - - - - - 549 



540 



541 



542 



543 



ib, 

544 
ib. 

545 
ib. 



THE 



AMERICAN JOURNAL 



OF THE 



MEDICAL SCIENCES. 



Art. I. Observations on the Treatment of Delirium Tremens^ and 
on the use of the Warm Bath in that Disease. Bj Thomas H. 
Wright, M. D. Physician to the Baltimore Alms-house Infirmary. 

X HE means commonly employed in the treatment of temulence and 
delirium from intemperance, were uniformly successful in the Balti- 
more Alms-house Infirmary, in a multitude of cases, for two years 
antecedent to the spring of the present year, 1829. Those means 
were emetics — afterwards mild cathartics, (Epsom salts and magne- 
sia,) in cases complicated with gastric and biliary derangements, or 
much febrile disorder; the evacuants followed promptly by anodynes, 
graduated in force or repetition, by the amount or persistence of nerv- 
ous disturbance. In cases of the disorder already arrived at the stage 
of per vigilant delirium, miscalled ^' mania a potu," (as is correctly 
remarked by Dr. Coates,) if high vascular tumult attended, we here 
also employed an emetic, afterwards a nauseant, tartar solution — as 
a sedative, and concurrently with the effects of the latter, opiates, 
in doses designed to enforce sleep, made full, and renewed so fre- 
quently as to have the effect of each successive dose to come in aid 
of the impression of those preceding. 

The opiate employed was Dover's powder, xij. grs. — orpure opium, 
one to two grains — or laudanum, forty drops — or black drop, x. gtt. ; 
the interval of exhibition usually two hours, but regulated by the 
symptoms. Where sensorial and nervous irritation were greatly ex- 
alted, attended by deficient reaction, and signs of general atony, 
small, quick pulse — cold surface — livid complexion, &c. all evacuants 
and direct sedatives were omitted, and the patient entered at once 
upon the use of opiates. But here the doses were made smaller than 
No. XI.— May, 1830. 3 



18 Wright on Delirium Tremens, \ 

in those cases where the sum of vital power was less obviously defi- 
cient or expended, and the force of opiate was graduated as nearly 
as possible to the torpor or exhaustion of the functions of general life. 
Here too cordials of the vinous or spirituous class were allowed, con- 
currently with the employment of the opiates; and it was to this stage 
of temulence that spirits and stimulant drinks of all kinds was re- 
stricted. It was only in cases where the tumultuous excitation of the 
cerebral and nervous functions was found associated with cold con- 
gestive torpor of the distributive system, or with a low, irritative 
grade of excitement, tending to rapid collapse, that we deemed it 
either medically or morally right, to renew even the temperate use of 
the primary agents of the disorder. 

In emetics, then, nauseants, anodynes, and cordials, regulated or 
combined in their exhibition by the character of cases falling under 
treatment, we had for a long time found efficient and unfailing means 
of controlling the various forms of temulence and delirium a potu. In 
no case of temulence advanced to the stage of delirious excitation, 
did we find emetics alone induce sufficient restraint of the cerebral 
and nervous derangements, to allow perfect tranquillity of mind, or 
sound sleep. Vomiting often took off much of the hallucina- 
tion of the patient, and substituted some intelligence for previous 
total folly; but there was a constant tendency to relapse into men- 
tal error, and we found it better to confirm the advantage gained 
from the emetic, by calling in the aid of opiates afterwards, rather 
than await the return of the delirious paroxysms, and trust to sub- 
due them by repeated emetics. The possible consequences of vomit- 
ing as a debilitating mean, suggests a caution in the repetition of 
emetics in temulent cases; and confidence in their permanent or final 
efficacy in those cases, is abated by the fact, that it is not uncom- 
mon to find some of the worst forms of delirium tremens, complicat- 
ed with, and aggravating under, almost constant spontaneous vo- 
miting: 

In cases of temulence with strong vascular action, which vomiting 
did not sufficiently calm, or where in such cases emesis was deemed 
improper, nauseants were employed in the form of drinks, charged 
with medicines of that class, sometimes tartar, or ipecacuan, or zinc. 
This given for some hours, seemed often to prepare the nervous sys- 
tem for a favourable impression by opiates, and we had frequent rea- 
son to infer, that after this mode of previous treatment, we succeed- 
ed in inducing quiet and sleep, with smaller and fewer doses of opi- 
ates, than in cases where such preparation was omitted or deemed 
unsuitable. 



Wright on Delirium Tremens. 19 

The opiate course of treatment did not always succeed without dif- 
ficulty, and sometimes not without an auxiliary of the sedative class. 
Cases of vigilant delirium which had resisted opiates singly, in full 
doses, repeated two, three, or four times, at intervals of one to two 
hours, were sometimes quieted by a liberal portion, ^eight to ten grains, 
of camphor, added to the next opiate dose. In a few instances, where 
opium alone, or in combination with camphor, had been used freely and 
diligently, withoutproducingeilher quiet or sleep, the addition of musk 
to the opiate has seemed suddenly to suspend the general temulent 
irritation, and sound sleep has soon followed. We have tried various 
modes of exhibiting the opiate in temulence, hoping to find some rule 
for its use, combining the greatest ef&ciency with the smallest quan- 
tity of the agent. We have administered it in half-grain doses, re- 
peated every thirty minutes, and in doses of one grain every hour — 
again beginning with half a grain, we have doubled the dose at every 
exhibition, in the ratio of compound increase, as far as we dare carry 
it on this rule. Each of those plans has succeeded^ but my experi- 
ence leads me decidedly to prefer half-grain doses of opium, or an 
equivalent in laudanum, repeated every half hour. The plan of dou- 
bling the dose at every exhibition, with the view of multiplying equally 
or more, the sum of quieting influence, often disappointed my expec- 
tations, and it was frequently necessary to arrest the experiment, and 
retrograde in the dose toward the first quantum. 

The form of opiate employed in temulence seems sometimes to in- 
fluence the result, as well as the amount. The pulv. Doveri answer- 
ed well in habits giving an inflammatory character to the grade of 
excitement associated with temulence, but from its tendency to de- 
press the tone of stomach, impair the appetite, and occasionally to 
vomit, as often as repeated, it sometimes became necessary to with- 
draw it before sufficient opiate impression had been made. Even 
where its depressing or disturb! ng'^efFect upon the stomach did not in- 
terfere with its continuance, it seemed to conduce to sleep less than 
an equal quantum of good opium or laudanum. Pure, dry opium, (the 
older the better, if well kept,) was long esteemed by us our surest 
antidote. In this disorder, however, experience taught us, that in ob- 
stinate cases, varying the form of the agent was sometimes produc- 
tive of benefit. In one case, where opium of the best quality had 
been exhibited to the amount of sixteen grains in twelve hours, with- 
out the smallest indication of submission to its influence, fifteen 
drops of black drop, at one dose, was followed by sleep in thirty mi- 
nutes, which lasted, with a single interruption of a few moments, 
fourteen hours. 

The web of the black spider has received commendation from many 



20 Wright on Delirium Tremens, 

respectable sources, as a sedative agent, capable of calming with pe- 
culiar ease and certainty, morbid excitability of the cerebral and 
nervous systems. On the credit of those qualities it has been employ- 
ed in the various forms of temulence, and not vv^ithout a share of re- 
puted success, sufficient to entitle it to consideration in that state of 
constitutional irritation. In the summer of 1827 we tried this article 
in many cases, and in full doses. To test its qualities, it was given, 
where the state of the patient admitted, un combined with opiates. 
When thus used, its effects were generally partial or doubtful, and 
its powers inadequate to the production of tranquillity or sleep. In one 
case only, have I found this substance to exert great or decided seda- 
tive attributes. This was the case of an intelligent young man, (in 
private practice,) who, after consuming, by his own report, three 
quarts of brandy, in thirty-six hours, fell into a state oftemulent ex- 
citation so excessive, that he was incapable of keeping a recumbent, 
or even a sitting posture, for more than a moment, but paced his cham- 
ber with a ceaseless step for two days and nights. He was not deli- 
rious, on the contrary his conversation was rational, though hurried 
and vehement. But he was so far under the influence of spectral hal- 
lucination, that if he closed his eyes for a moment, day or night, he 
was instantly visited by a host of phantoms of frightful aspect;* 
hence chiefly his aversion to lie down, or make any voluntary effort 
to sleep. This patient took opium, opium with camphor, and black 
drop, at short intervals, and in full doses, until the quantum of opi- 
ate, approached the utmost limit of probable safe administration, with- 
out even partial relief of constitutional irritation, or any apparent 
proneness to sleep. The temulent excitement kept unabated for 
twenty-four hours, the second night passed in constant vigilance, lo- 
comotion, and mental excitement, and it seemed probable that exci- 
tation so intense, protracted, and unremitting, must soon lapse into 
delirium or convulsions. At this time, the morning of the third day, 
(the second of my attendance,) he began the use of the fresh web 
in pills of five grains every hour. Its effect was prompt and unequi- 
vocal. He calmed, even sensibly to himself, with every dose, and 
watched with desire for the time of repeating the pills. The first 
effect of the web was to abate his restless movements about the 
room, he became disposed to sit down, and kept his chair, with short 
intervals of walking, for some hours. In the evening he consented 

* Among" the delusions practised by imagination on reason, the impulse 
to self-destruction was predominant; a catastrophe said to have been unhappily 
realized in less than a year after, while confined in one of the public institu* 
tions on account of derangement from drink. 



Wright on Delirium Tremens, 21 

to go to bed, got up once or twice, but returned to bed without diffi- 
culty, took an opiate at night, the first for eighteen hours, and slept 
continuously for eight hours. The cure was completed without diffi- 
culty, by repeating the web less frequently next day, quiet, suitable 
nourishment, and another opiate at night. The patient spoke emphati- 
cally, both the first and second day, of the soothing influence produced 
by the pills. He was not at the time informed of their composition. 

On the general plan, and by the agents indicated in the preceding 
outline, we had for two years uniformly triumphed over the multitude 
of temulent affections, which in slight or severer forms, almost daily 
enter the wards of our institution. The result of a few cases of the 
disorder, admitted in the spring of the present year, 1829, showed 
us the error of counting on the infallibility of the means of past suc- 
cess, and diminished, perhaps unduly, our confidence in agents so 
frequently sufficient for our purpose. In June of this year we had 
three cases of delirium tremens, in which the power of sedatives and 
opiates, combined with our best judgment, and administered with all 
our skill, was found unequal to cope with the disease, and we incur- 
red defeats the more unpleasant because novel and unexpected. The 
first of those cases exhibited the disorder of the cerebral and nervous 
functions, associated with high tumult of the vascular system; coun- 
tenance wild and flushed; pulse full; skin dry and hot; tongue foul; 
patient reported to have been two days and nights without sleep. 
The treatment was commenced by emesis, afterward nauseants, tar- 
tar in barley water, until febrile excitement was somewhat dissolved, 
then the opiate course in full doses. Dover's powder, twelve grains, 
forty minutes interval; solid opium in doses of two or three grains, 
one hour distant; and finally, strong laudanum, thirty drops in twenty 
minutes, were successively exhibited with punctuality, without any 
good effect. Per vigilance, agitative tremor and delirium increased, 
and the patient died in twenty-four hours after admission, exhausted 
by excessive unremitted mental excitation, and temulent struggles. 

The second was a case of relapse, or rather of the disorder renew- 
ed with multiplied intensity. The patient had been admitted with 
temulence in its forming stage, cerebro-nervous irritation below the 
grade of delirium, but tending to that consummation. He was put 
alone, and treated, (after a mild emetic,) by opiates of medium 
doses. He tranquillized readily, slept great part of the first night, 
was rational next morning, and eat breakfast with good appetite. 
In the evening he was removed from the cell to the general infirmary, 
where he slept well, and was so much himself on the day after as to 
engage voluntarily and actively all day in assisting the nurse of the 

3* 



22 Wright on Delirium TVemens. 

infirmary to wait on the sick. On the second night of his stay in the 
infirmary, he awoke late at night with a cry of terror, expressed 
vehement dread of some vague danger, and became so agitated, (te- 
mulent,) that it was necessary to transfer him again to solitary con- 
finement. His case soon reached the acme of sensorial disorder. 
Acute phantomic delirium became established, attended by extra vi- 
gilance and a low grade of febrile irritation^ pulse small and quick, 
countenance dark, tongue red and dry, surface cold. The unfortu- 
nate result of the case just preceding, had created suspicion that the 
fatal event might be resolved either into the loss of time devoted to the 
reduction of excitement, by the emetic and nauseants, or in part to 
that cause and to the too tame use of opiates afterwards. To give 
the opiate full scope, it was resorted to in the present instance, at 
once and freely. A bolus of opium and camphor, (2 grs. and 4 grs.) 
was given every hour, until the quantum of opiate taken had reached 
eighteen grains: its exhibition was then arrested to await its effects. 
After an interval of three hours, and neither quiet nor sleep appear- 
ed at all likely to ensue from what had been taken, four grains, full 
weight, of opium was given at one dose. The eff*ect of this experi- 
ment of doubling the dose after so much previous opiate exhibition, 
was looked for with anxiety. An hour after its administration the 
patient was more excited and restless than before, and soon went into 
convulsions wliich never ceased till death. The third case was in the 
low ataxic form of muttering stolidity, comprehending nothing and 
expressing nothing distinctly, constantly catching at spectres, and 
turning up the bed clothes and bed after some visionary object of 
search. It was treated by cordials and opiates, with stimulants, 
wine whey, laudanum with spt. amnion; stimulant anodyne enemata, 
laudanum and tinct. foetid, in warm water. The case ended fatally, 
by slow exhaustion, on the third day.* Period of temulence before 
admission, not known. 

Dissection, in the first case, revealed universal injection of 
the vascular series of the encephalon, both in the membranes and 
medullary body; excess of serosity over the surface of the brain 
and between the tunics; no sanguineous extravasation. In the sto- 
mach, fine red injection around both orifices, florid patches in the 



* This man was for the most part unable to swallow, but after holding' sub- 
stances for some time in his mouth, they would suddenly drop out, while he 
appeared making" efforts to convey them into the stomach; as if the nerves of 
the tongue and pharynx were paralyzed by congestion or effusion at theif- 
root. 



Wright on Delirium Tremens. 23 

mucous tissue, no lesions elsewhere. In the second case, the state 
of the encephalon and stomach exhibited something of engorgement 
and phlogosis, but the marks of congestion in the brain, and of irri- 
tation in the stomach, were sensibly less than in the first subject. 
The small intestine was much inflated in this case, and in one part, 
the jejunum, for eight inches, the coats of the bowel were loaded 
by extravasated blood, (ecchjmosis.) The quantity of blood infil- 
trated into the cellular tissue of the coats of the bowel, chiefly on the 
side of the tube next the wall of the belly, was very considerable, 
and had the appearance of interstitial haemorrhage by contusion. There 
was no appearance of bruise on the outside of the abdomen, and it was 
not known whether the patient had been hurt in any way by a fall, 
blow, or other accident. The third subject betrayed no other patho- 
logical phenomena, than a very loaded state of the sinuses of the 
brain and of the veins of the cerebellum. The medullary substance of 
the latter was of very distinct pink colour throughout. 

Of numerous cases of temulence, averaging sixty per annum, 
and a large proportion in its gravest forms, admitted into the house 
within the two years, ending 1st of July, 1829, those just reported 
are the only fatal instances; or rather what is meant is, that they are 
the only instances which have finally resisted treatment. Some other 
victims of intemperance died in the house within the period mention- 
ed, but these, five or six in number, were cases brought to the house 
in a state of absolute exhaustion or fatal stupefaction, and have died 
in a few hours after admission, one or two of them on the road to the 
institution. One case occurred lately, (in August,) in which the cir- 
cumstances and the manner of death dift'ered from any former exam- 
ple. A young woman was brought at night to the institution in that 
state of temulence with terror, called by the nurses and old inmates 
of the house, the horrors. She was put to bed, a cordial anodyne ex- 
hibited, and its repetition at stated intervals charged on the matron 
of the cells, if the patient did not sleep. In the morning, early, the 
matron reported to the senior student, that the young v/oman had 
slept great part of the night, had waked in the morning calm and 
cheerful, and after taking breakfast with appetite, had again fallen 
asleep. In an hour afterwards she came to report, that having gone 
into the cell to observe if the patient was sleeping, she found her lying 
in the posture, and with the appearance of sleep, but lifeless. Dis- 
section furnished no satisfactory explanation of the cause of death. 
The cavities, tissues, &c. were all in their common state, ex- 
cept at one part. The cellular tissue enveloping the left kidney 
was infiltrated with blood, and extensively stained by red se- 



24 Wright on Delirium Tremens. 

rositj. The senior and associate students engaged in the examina- 
tion of this woman, report a sensible effluvium of whiskey from the 
stomach, but a still more distinct and even strong odour of the same 
liquor from the brain of the subject. 

The senior student of the house treated the thr-ee cases reported 
as ending fatally, with particular personal superintendence. They 
were treated according to general advice given by myself, and with 
the advantage of knowledge, zeal, and good judgment on the part of* 
the gentleman in charge of them, aided by former observation of the 
judicious management of similar cases in the Pennsylvania Hospital 
and Alms-house. After the unfortunate issue of those three cases, it 
became a question of great interest to this gentleman, (whose station 
in the house threw most of such cases into his hands,) what means 
were left us or what could be done to avert similar defeats in future. 
When consulted in one of the gases reported, which had resisted two 
and three-grain doses of good opium repeated to three or four exhi- 
bitions, about the propriety of pushing the opiate to such absolute 
force of dose as must decide the alternation of "sleep or death" in 
favour of the patient, I had expressed strong doubts of the safety of 
great multiplication or progressive increase of dose in those states of 
exalted and protracted temulent excitation. I conceived it highly 
probable that in such cases extra large doses of opiate, might, as a 
narcotic, suddenly extinguish the remains of sensorial energy, or else, 
as a stimulant, urge the existing sum of constitutional irritation to a 
grade of uncontrollable excess, speedily involving convulsions or fatal 
collapse. The general phenomena of poisoning by opium and some 
other narcotics, are often very analogous to the symptoms of per 
acute delirium tremens from drink;* and it has been long matter of 
apprehension with me, that our plan of treating high temulence was 
liable to the serious risk of supplying the train of morbid actions with 
an impulse fitted to carry them on to direct augmentation. In one 
of the cases reported above, where eighteen grains of opium, two 
grains in the hour, had been take i, after suspension of the opiate 
three hours without the least apparent controul of the symptoms, be- 
tween four and five grains were given at one dose. The delirium in- 
creased, convulsions ensued, and continued until death. 

The state of super-excitation in temulence, seems to require agents 
fitted to soothe without disabling, capable of calming irritation at 
small expense of power. Evacuants are apt to exhaust too much, 
stimulants to excite unduly; with both vigour is lost while tumult re- 

* Which often kills, no doubt, purely from narcotism. 



Wright on Delirium Tremens. 25 

mains. On these general principles, our practice has for some time 
been regulated more strictly than formerly. We have endeavoured 
to pursue a course adapted to circumstances, combining caution viith 
effect, and interposing in a manner neither too absolute nor too tame. 
Evacuants, emetics and mild cathartics, if indicated, or injections, 
if for any reason preferable, were employed as hitherto in cases where 
the patient was young and stout, the disorder in the first stage, the 
vascular function active, and gastro-biliary derangements indicated 
by foul tongue, want of appetite, nausea, &c. If with the evidences 
of the tonic form of excitement, gastric, or gastro-cephalic irritation 
predominated in the characters of great sensibility about the stomach, 
pain of the head, over acute hearing, intolerance of light, flushed 
face, &c. cupping the epigastrium, the temples, fore and hind head, 
or all, were to precede, and, in exalted grades of those local derange- 
ments, to supersede direct medicinal evacuants. If delirium, per 
vigilance, or high temulence survived the preparatory treatment de- 
scribed, as they too often do, the warm bath was to be the next re- 
sort. The temperature of this agent was rei2;ulated by the state of the 
patient, as a general rule about 90°, its duration to be determined by 
its effects, always contemplating manifest calming influence before 
the experiment was arrested. The opiate course succeeded imme- 
diately to the bath. Dover's powder or pure opium, in the propor- 
tion of one grain to the dose, (or an equivalent in laudanum,) was 
given every two hours, if necessity continued, to the extent of three, 
or at most four doses. If this trial with the opiate did not succeed 
in inducing quiet or sleep, the warm bath was repeated, the patient 
kept in until sensibly, but not greatly relaxed, and on his coming out 
of the bath, the opiate again resorted to, but in a retrograde ratio. 
Instead of renewing now the amount of opiate first employed, the 
dose was reduced at once to one-half, even more than half if the pa- 
tient was much languid from the bath, and repeated at intervals of 
an hour, until sleep was procured. 

In cases of the atonic form of temulence with delirium, where the 
disorder had been longer formed, the vigour of the subject constitu- 
tionally small, or subdued by habitual intemperance, sensorial and 
nervous irritation abounding, with a small, quick, undeveloped pulse, 
skin cold or covered with mucous perspiration, in short, in cases com- 
bining the asthenic and irritative forms of the disease, all evacuation 
by vomiting or purging was pretermitted. Here moderately stimu- 
lating injections were employed until stools were procured, cups ap- 
plied to the head or epigastrium, or both, if gastric and encephalic su- 
per-irritation were present, the warm bath, and after its use, opiates, 



26 Wright on Delirium Tremens. 

in force of dose and frequency of exhibition, regulated by the seem- 
ing indications for a prompt or gradual impression. In every modi- 
fication of the class of cases under consideration, the atonic or asthe- 
nic forms of temulent delirium, the doses of opiate were compara- 
tively small, never exceeding the ratio of one grain to the hour, and 
reduced from that amount if tranquillity or sleep was not consum- 
mated by the first three or four doses. Always before commencing 
the use of the diminished doses of the opiate, the warm bath was re- 
peated, and it generally, in fact almost uniformly, happened that after 
repetition of the bath, the reduced doses, (half proportions,) display- 
ed more composing and greater hypnotic influence than the previous 
full doses had accomplished; often succeeding perfectly in the same 
number of doses as had failed altogether on the first trial with dou- 
ble the quantity of opiate. 

This result became so manifest and so often repeated, that the stu- 
dents of the institution fell into the habit of exhibiting the opiate in 
small doses even at first, and going on with them continuously, until 
the symptoms were subdued. Where the disorder proved obsti- 
nate, and the bad symptoms unusually protracted, instead of re- 
sorting to large doses of opiate, injections sometimes with tinct. 
foetid, or laudanum, cupping,* or that mean repeated if used before, 
and renewed warm bathing, were called in as auxiliaries to the opi- 
ate course. Cases have occurred in the house in which high delirious 
temulence has kept on for two and three days and nights, and yield- 
ed happily at last to the course indicated. An instance of this sort 
occurred a few days since, (a foreigner of education and respectable 
connexions, fallen from his rank by habits of intemperance,) where 
the disorder wore a character of peculiar exaltation and inveteracy. 
The man did not sleep nor even lie down for three days and two 
nights. Incessantly and vehemently declaiming to and of the crea- 
tures of his own morbid imagination, he stood shaking under an im- 
pulse irresistible and unremitting, which while it rendered both mind 
and body the sport of its power, seemed to impart superhuman abi- 
lity to endure the unnatural privation of rest or relaxation. The 
warm bath frequently repeated, with laudanum renewed continually 
in doses varying from twenty and thirty down to ten drops, succeed- 
ed at last in calming an amount and persistence of tumult, which for 

* Cupping the temples, in hig-h delirium, was followed by cold applications 
to the head. We have bled from the arm but in two cases, one of stupor, the 
other remittent convulsions, both with dilated pupil and full pulse. In each 
the pulse quailed promptly under the flow of blood. Both recovered under 
subsequent treatment. 



Wright on Delirium Tremens. 27 

a long time appeared likely to intermit only by total expenditure of 
the vital attributes by which it was sustained. The whole quantity 
of laudanum exhibited in this case was two hundred drops; two or 
three ten-grain doses of Dover's powder were given on the night of ad- 
mission, in anticipation of the laudanum course. In a milder form, 
the disorder, (temulence with hallucination,) sometimes maintains- 
its partial dominion over the patient for a long period. A man of 
fat full habit was lately discharged the Alms-house Infirmary, in 
whom temulent agitation with tendency to delirium continued three 
weeks. Every day during this period, his limbs were tremulous, his 
countenance anxious and terror stricken, pulse small and quick, sto- 
mach irritable. During all the time whenever he fell asleep, day or 
night, he was shortly awaked by some indefinable feeling of agitation 
and alarm, and found himself covered with profuse perspiration. He 
did not at any time fall into actual delirium, but his confusion of mind 
was often very great for a few minutes. He was treated by the warm 
bath daily, and the vegetable bitters with ten-drop doses of laudanum 
at intervals generally of six hours. He recovered perfectly at last. 
Throughout the treatment he was constantly solicitous that the indul- 
gence of the warm bath should be continued to him, and spoke 
strongly of its comforting influence. 

Our general design, (as was mentioned,) in the exhibition of the 
opiate, has been, to procure its tranquillizing influence, by renewing 
the impression of small doses at short intervals, and thus to multiply 
opiate power, until we acquire dominion over temulence, without in- 
curring the hazard of a constitutional shock, either by the narcotic or 
super-excitant force of one or more large doses. In the greater num- 
ber of cases, the dose of opiate we employ is ten drops of good lauda- 
num,* at intervals of forty to sixty minutes, and whatever be the re- 
sult, the dose is rarely raised to twenty drops. Beyond the latter 
dose we almost never go, and not at any time for more than two or 
three doses, the larger portions of opiate generally given in the first 
trials with that mean, and consisting commonly of pulv. Doveri in 
eight or ten-grain doses. In cases, where, from the long period of vi- 
gilance before coming to the institution, the necessity for sleep has 
become peculiarly urgent, after preparation by injections, cupping if 
indicated, and the warm bath, we treat with twenty drops of lauda- 
num in succession, at intervals of forty to sixty minutes. After such 
cases have been brought to acknowledge the influence of the opiate, 

* Laudanum is the most convenient form of opiate in those cases, from the 
greater facility and certainty of its exhibition to delirious patients. 



28 Wright on Delirium Tremens. 

to the degree of partial sleep or manifest drowsiness, we often reduce 
the force of that agent, as the symptoms of the disorder yield, and ad- 
hering to short intervals of repetition, exhibit the laudanum in por- 
tions of ten, or even five dr6ps. Often, very often, do we find reviv- 
ing vigilance, or the wavering tendency to sleep, converted into 
sound repose, by the constantly renewed impression of even those 
very small doses. 

There may appear to be good reason, from the force of the disor- 
der, and the active treatment by opiates, generally pursued and often 
successful, to suspect the plan of management briefly sketched above, 
as inefiiciently tame, and therefore of pernicious tendency. I can 
only reply, seriously, that I should deem it criminal to misrepresent 
in such a matter, and that whatever be the speculative probability, the 
practice described has in reality been eminently successful. I have 
now before me a report from the senior student of the institution, of 
which the following is an extract: — 

'* Of thirty-nine cases of delirium tremens and temukntia, admitted into the 
house from the third of July, 1829, till the thirtieth of December of the same 
year, twenty -five were explicitly delirious. Three of the subjects of it died. 
One of those entered the institution convulsed, and continued thus till death, 
which occurred in a few hours. Another was labouring at the time of entrance 
under apoplectic stupor, and eventuated similarly in a like period. The third 
was in an extreme state of debility, and died the ensuing morning. In this num- 
ber the last very singular case admitted is not embraced, but it forms a very 
striking example. The event is yet unaccomplished."* 

* The case here mentioned by the reporter as " singular," was briefly as fol- 
lows. The man when admitted was in total stupor, said to be the effect of hard 
drinking for some days. Next morning he was highly temulent, shaking in all 
his limbs. His countenance now expressed consciousness, and when spoken to 
he moved his lips and tongue, but could not articulate. In the course of the day, 
after great effort, he sometimes pronounced monosyllables. On the third day, 
countenance calm and natural, speech still limited to one word; farther effort 
to speak was either inaudible, or produced interrupted unmeaning murmur- 
On pressing with my finger on the ligament which covers the exit of the spinal 
chord through the foramen magnum, the right side of the face became con- 
vulsed, and retracted forcibly toward the ear. This spasm and retraction was 
uniformly repeated when pressure in the neck was renewed, and continued the 
same for thirty-six hours. The left side of the face pricked freely with a pin, 
acknowledged no sensation; the right was readily stimulated to contraction by 
the same mean. The man lost all the marks of temulence after a few days, and 
gradually recovered the power of speaking short sentences. But even now, ten 
days after complete general convalescence, any effort to converse beyond a few 
simple terms, produces apparent chaos of ideas and confusion of language, 
causing him to utter abruptly unmeaning words, made up of incongruous letters. 



Wright on Delirium Tremens. 29 

*'* All of them were treated by the same means now always adopted by us, 
and we believe with particular success. Of the merely temulent cases, none 
proved fatal." 

" Antecedent to the 3d of July, and previous to the system at present esta- 
blished in this institution, out of four cases of delirium tremens successively 
admitted, three had proved fatal. (These were the cases described in the for. 
mer part of this memoir.) The plan then was opium, camphor, and musk com- 
bined, or some form of opiate exhibited in large doses, and at greater Intervals 
than we now observe. One of them, (of the three cases mentioned,) expired in 
convulsions, probably induced by the opium, of which three-grain doses, and 
one dose of four g-rains, had been administered to the extent of twelve grains. 
Emetics were succeeded by death in a second of those cases." 

"In addition to the above thirty-nine cases, were several of a milder form ot 
the disorder, which did not require very strict medical attention." 

"R. J. THOMPSON, Senior Student.'' 

If it were asked on what I conceived to rest the main efficacy of 
the treatment here reported as having almost uniformly overruled te- 
mulent delirium in its most grave forms, I should reply, first, the 
warm bath^ secondly, liberal cupping on the abdomen and head, the 
latter especially. The very temperate opiate course which has fol- 
lowed those means and consummated the cure, I re";ard as owina; its 
efficiency chiefly to the constitutional preparation, accomplished by 
the primary and concurrent employment of the former agents. Un- 
aided by those auxiliaries, I conceive the small doses of opiate would 
often expose to defeat, in a contest with so formidable a disease. 

I do not know whether the free and repeated employment of the 
warm bath, be a new practice in the treatment of delirium tremens. 
I am not apprised that it has ever been used in that affection, but my 
information on the modes of treatment in that disorder, derived from 
reading, is very limited. It has so happened that I have seen none of 
the essays published on the subject abroad or at home. Some of the 
latter* are highly esteemed by the profession, as happily illustrating 
the pathology of the disorder, and indicating judicious and rational 
principles of treatment. There is no design in those remarks to at- 
tach importance to the question, whether the agent recommended in 
this memoir be now for the first time used, either partially or freely, 
as a composing mean in temulent irritation. It is far more interest- 
Pressure in the neck no longer causes spasm in the flice, and sensation is equal 
on both sides. During illness, and for some days after, the bowels and bladder 
were evacuated unconsciously. Treatment — injections, warm bathisg, repeat- 
ed cupping on the head, and small opiates. 

* Essays on "Mania a Potu," or "Delirium Tremens," by Drs. Klapp, 
Coates, and others. 

No. XL— May, 18S0. 4 



30 Wright on Delirium Tremens. 

ing that it prove beneficial, than to establish for it any pretension to 
novelty. 

There are some extra medicinal considerations connected with the 
management of delirium tremens, of sufficient consequence, in hos- 
pital practice especially, to merit particular attention. As the sub- 
jects of this disorder commonly require to be kept alone, in hospitals 
generally secluded in cells, it is highly important that their place of 
confinement be as quiet as possible, and capable of being made light 
or dark at pleasure. But it is even still more important that the re- 
ceptacles of this class of patients be dry, and susceptible of being 
ventilated in summer, and warmed comfortably in the damps and 
cold of autumn and winter. Nothing, not even light and noise, so 
strongly counteracts the good tendency of the most judicious medical 
regimen, as a close, damp, or chilling atmosphere, about the subject 
of delirium tremens. The patient cannot tranquillize — there can be 
no balance of the sensorial and natural functions, while the nervous 
and capillary tissues, the exhalent system of the lungs and the skin, 
are paralyzed by submersion in an atmosphere at once impure, and 
damp, and cold. Salutary reaction toward the surfaces, the offices of 
elaboration, and all the constitutional means of equipoise, are utterly 
hindered under such evils of place and circumstances. A dry air, 
kept comfortably warm, yet admitting due ventilation, clean, dry, 
and sufficient personal dress, (if the patient is up,) a dry bed, and 
sufficient covering, these are almost indispensable to the safety of 
patients far advanced into constitutional temulent irritation. 

Next to comfort of place, personal management is a matter of im- 
portance. The hallucination, the wandering impulse and ceaseless 
motivity of high temulence, suggest an apparent necessity for per- 
sonal restraint, as well as solitary confinement. Even as a mean of 
composure, as an auxiliary to the sedative and quieting course of me- 
dicines, personal hindrance from motion and effisrt seem at first view 
to be necessary, and has often been resorted to in those cases. Hence 
the tranquillizing chair, the leg chain and the mufflers for the hands, 
the straight waistcoat for the arms and trunk, and the bed straps to 
enforce recumbency. These and other means have been employed to 
prevent the patient from beating the bounds of his cell with restless 
step and agitated limbs. But every such device is commonly vain. The 
temulent agitation is no less vehement, because confined within the 
close embrace of the canvass shirt; muscular action then becomes 
concentrated, not extinguished. The temporary madman, unconsci- 
ous of the motive or design of such constraint, feels the incumbrance 
most sensibly, and from the instinct to be free, strains yet more 



Wright on Delirium Tremens, 31 

and more, and is not likely to relax his efforts, until fatal exhaustion 
quenches the power to struggle. Of all the means of personal re- 
straint I have seen employed in motive and agitative temuknce, my 
own observation would lead me to retain only the leg chain, confining 
the patient to a small space near his bed, leaving the trunk, arms, 
and hands free, and removing out of his reach every thing he could 
injure, or with which he could hurt himself. I have seen subjects of 
the disorder, standing up, or lying upon their beds, under the com- 
pression of the straight jacket, in whom the tumult of mind had con- 
stantly augmented after it was put on, as if to compensate for the bo- 
dily controul thereby produced. Those cases long resisted all the 
agents of quiet employed while the constraint was kept up, and in 
most instances it became necessary to throw the jacket off before 
either mind or body could be calmed to rest. An instance occurred 
lately, in the case of a robust old man, apparently about sixty, whose 
delirium had been unusually protracted, and of a character to render 
the temporary use of the jacket necessary.* We found him standing 
up, vigilant and excited, without the smallest sign of submission to 
the opiates which in moderate doses had been diligently administer- 
ed; he had not lain down since the evening before, and nothing but 
force would have put him or kept him in bed. He complained much 
both of the inconvenience and the indignity of the personal con- 
troul, and on being asked by the senior student whether he would go 
quietly to bed if all restraint were removed, he consented to do so. 
He was set at liberty, lay down, and was reported by the keeper of 
the cells to have fallen asleep in a few minutes. He was rational 
next day, and continued well. From all that I have seen of the dis- 
order, our experience appears to warrant the conclusion, that in the 
warm bath, properly used, we have a most salutary substitute for for- 
cible restraint; a substitute which at the same time that it controuls 
powerfully, yet soothes while it subdues. 

We have made the course of diet for the temulent as simple as pos- 
sible. Coffee, or chocolate, or milk and bread, for breakfast; rice, 
gruel, or light vegetable soup for dinner; tea or milk with bread for 
supper, constitute the common regimen. It has been mentioned be- 
fore, that laudanum is our general form of opiate in the disorder. 
This we administer in wine whey, the latter made with wine of good 
quality, and besides using the whey as a vehicle for administering 
the opiate, the patients are allowed the same, (except contraindicat- 

• He had been unavoidably placed in a cell with another patient for whose 
security from annoyance or hurt the constraint was imposed. 



32 Wright oji Delirium TreTuens. 

ed by the grade of excitement,) as a drink. Beyond this kind and 
amount of cordial exhibition v/e never indulge. Spirituous drink of 
all kind is entirely excluded from our plan of treatment. Formerly 
we allowed in some cases of the disorder, small quantities of spirits, 
diluted and sweetened, (toddy,) in connexion with the opiate course, 
but for a long time we have omitted that mean altogether. No pa- 
tient, to the best of my knowledge and belief, has suffered from the 
privation, nor do I think the allowance of spirituous drink in this class 
of cases, either necessary or judicious; at least such indulgence is by 
no means generally essential or conducive to the cure. 

When first entering on hospital practice, where the temulent form 
of disorder was like to be frequently encountered, it became a ques- 
tion with me whether I might safely withhold spirituous drink from 
the subjects of that affection, betraying a predisposition to the disease 
in its mature stage, namely, prepared to lapse into agitative delirium. 
The experiment seemed both morally and medically worth making, 
if it could be done with safety. It was trifed and succeeded. With 
very rare exceptions, liquor, spirits, wine, &c. was kept wholly out 
of use, and the temulent subject treated by rest, (sometimes confine- 
ment to bed for a day or two,) with sufficient allowance of light nutri- 
tious food, and generally a small anodyne at night. I have seen no 
reason to consider this course unsafe, or calculated to give temulent 
irritation occasion or opportunity of serious aggravation. Very many 
who come into the wards with bodies agitated and minds somewhat 
distempered by temulence, on being put to bed, made warm and com- 
fortable, supplied with suitable and sufficient nourishment, and, if re- 
quired, a medicinal cordial or anodyne, have tranquillized readily, 
and escaped the further dominion or the full establishment of the dis- 
order. On the whole, I am sincerely convinced that the administra- 
tion of spirituous drink is not generally necessary or beneficial in 
temulence, either as a preventive or remedial mean. 

On the subject of tlie medicinal employment of spirituous liquors 
in general hospital practice, our experience sustains a conclusion of 
some interest, especially as it relates to the moral and economical 
aspect of hospital regimen. Our annual summary of cases treated, 
for twelve months, ending 1st of May, 1828, gives 1873 patients. 
A similar estimate for the year ending 1st of May, 1829, furnishes 
2167 cases. By a report of the agent of supplies for the Alms-house, 
the whole quantity of liquors ordered for the institution during those 
two years, was as follows: — 

"For the year ending- 1st of May, 1828, 50 gallons of wine, 3 barrels of whis- 
key, 8 gallons of Jamaica spirits, 1 gallon of gin, 1 dozen bottles of porter* 



' Toy^s Case of Pregnancy, 33 

For the year ending 1st of May, 1829, 48 g-allons of wine, 2 barrels of whiskey, 
7 gallons of gin, 6 gallons of spirits, 2 gallons of French brandy. 

"T. R.HAND, ^gew/." 

The " whiskey" mentioned in the report of the agent, w^as used 
for various purposes, in the house, chiefly stimulant fomentations, lini- 
ments, &c. and for making common tinctures. None of it was ad- 
ministered to patients, except as made into tinctures. There remains 
then, of wine, spirits, brandy, &c. a total of one hundred and twenty- 
eight gallons used in two years, with an aggregate of patients in the 
time amounting to four thousand and forty. In a professional view, 
the first question which ought to associate itself with such an ex- 
hibit, is whether the subjects and diseases of hospital practice will 
safely admit so restricted employment of stimulant means. If 
my judgment and experience have not both greatly deceived me, I 
can conscientiously answer in the afiirmative. My real conviction 
is, that what error we committed in the use of those agents was on 
the side of indulgence rather than restriction — that we gave too much 
instead of too little. The total mortality in the institution, for the 
two years indicated, was 322, number of cases 4040, ratio of deaths 
about twelve and a half per cent. A result it is conceived not less 
favourable than has obtained in any similar establishment abroad 
or at home. The ratio of mortality here given, will be greatly re- 
duced in a medical contemplation, by the fact that the aggregate of 
deaths reported comprehends one hundred and two cases of pneumo- 
tuberculitis, or chronic phthisis pulmonalis. 

Baltimore, December, 1829. 



Art. II. Extraordinary Case of Pregnancy in which the Foetus was 
Discharged through the Mdominal Parietes. By Joseph A. Toy, 
M. D. of Virginia. 

Early on the morning of the 1st of November, 1828, I was de- 
sired to visit Mrs. S. W. in the adjoining county, (Warwick,) who 
was represented as being extremely ill. Dr. French of this town 
had also been called on, and we visited her together. On our arrival 
we found Dr. Corbin, (of Warwick,) the attending physician, pre- 
sent. Dr. C. has since very politely furnished me with the previous 
history of the case, from which I learn that the doctor saw her incir 
dentally on the 29th of October, at which time he bled her freely. 

4* 



34 Toy's Case of Pregnancy* 

She then had a midwife with her, and was supposed to be in labour* 
The doctor was called again on the evening of the 30th, at which time 
he represents her as labouring under all the symptoms which charac- 
terize labour. On the following day the pains increased in violence 
and duration, and upon examination the membranes were found to be 
tense and advancing slowly. In the evening '' the pains were of long 
duration, and appeared, natural. On examination found the os uteri 
considerably dilated and labour appeared fast progressing; put my- 
self in an attitude to render the assistance customary, and in a few 
moments the sac, whose progress I had so anxiously watched, burst, 
and a rapid and bold current of water followed. From the length of 
time it w^as passing, and the deluged state of the bed and room, I 
think I may with confidence state that the quantity must have been 
two or three gallons." We were called on the following morning. 
We found the lady suffering extremely. She described the pain as 
being "a dull, heavy aching" across the abdomen. The abdo- 
men was swelled, tense, and hot — pulse small and quick — great 
restlessness and anxiety — os tincje soft and somewhat dilated — 
the external parts were swollen and inflamed. Emollient fomenta- 
tions were applied, and it was determined to use the secale cornu- 
tum to promote the expulsion of the foetus; half a drachm was given 
in divided doses, one-third every twenty minutes, conjoining a sudo- 
rific anodyne with the first dose. This produced no apparent effect 
upon the uterus, and we continued to use it until two drachms were 
administered. We could not perceive, however, that the slightest 
effect was produced by it, and we judged it prudent to stop its 
use. In the meantime our patient had become almost entirely easy, 
and the swelling, tenseness, and heat of the abdomen were greatly re- 
lieved by the fomentations. Aperient and febrifuge medicines were 
prescribed for her, with an anodyne at night to procure rest. When 
I saw her the next morning, she was very nearly as on the preceding 
day, except that on examination the os tincse was found more con- 
tracted — the tension and heat of the abdomen were almost entirely 
relieved. We had not been able to perceive any thing like a foetus 
by examination per vaginam, but a tumour which we supposed to be 
the head of the foetus was distinctly perceptible two inches abov^ 
and to the right side of the umbilicus. 

The patient was quite composed, and in better spirits than on the 
day before. She informed me that she had not " looked" until De- 
cember. It was thought unnecessary for us to continue our attend- 
ance, and we accordingly left the case to the care of the attending 
physician. The doctor states, in the communication before alluded 



^oy^s Case of Pregnancy* 35 

to, that she was "extremely ill" several times within the succeed- 
ing ten days. On the 10th, her face, feet, and legs were swollen, and 
there was considerable fever present. On the 12th there was an of- 
fensive discharge from the vagina, ''resembling matter from an ul- 
cer." On the 18th all unpleasant symptoms abated except swelling — 
discharge very considerable and offensive. The doctor ceased visiting 
her about the last of November, at which time the discharge was very 
considerable. 

I heard nothing of this case from the time I saw the lady until Ja- 
nuary, 1829, when her husband called on me, and desired that I 
would prescribe for her. He stated that her face, feet and legs were 
much swelled. That she was extremely feeble and her general health 
bad. The discharge per vaginam still continued, and within the last 
three weeks several small bones had been discharged. These I after- 
wards ascertained to be an entire forearm and hand, and the meta- 
carpal bones and fingers of the opposite arm. He said that it had 
been several weeks since any physician had seen her, and that she 
was very melancholy, and considered her case a hopeless one. I pre- 
scribed for her Peruvian bark and carb. ferri, with stimulating pedi- 
luvia, and frictions and flannel rollers to the legs. Mild aperients to 
keep bowels soluble. As this lady lived a considerable distance from 
here, I lost sight of the case entirely until May following. Her hus- 
band now called on me again to know whether any thing could be 
done for her. He stated that the swelling was entirely removed from 
the feet and legs, and that her health had improved under the tonic 
course. She had been to Norfolk about six weeks previous, and 
consulted Dr. P. Barraud. 

I was desired to visit her in conjunction with Dr. Banks of this 
town. We saw her together on the 7th of May. She was sitting up, 
but not able to walk further than across the room at once. She in- 
formed us that six or seven weeks previous, a small discoloured spot 
had appeared about one inch above the umbilicus on the right side, 
and that she suffered considerable pain about this part. There was 
now an aperture at this spot, through which a tine probe could be in- 
troduced. The discharge per vaginam had ceased altogether about the 
last of January, but there was now a small discharge from the abdo- 
minal opening. No bones had been discharged since those before 
mentioned. We stated to her our conviction that there was but one 
means of relief for her, and that was an operation for the removal of 
the bones. That as there had been no discharge per vaginam for more 
than three months there was not the slightest probability of their be- 
ing discharged from that passage, and as nature had already done so 



36 Toy's Case of Pregnancy, 

much for her, there was a strong probability of her entire recovery 
after the operation. She would not, however, consent to have them 
removed. We prescribed for her an infusion of quassia, gentian, co- 
lumbo, and rhubarb, and as there was considerable tension and heat 
about the abdomen an emollient poultice was directed. We agreed to 
visit her alternately once a week. When I next saw her, on the 21st, 
her strength had increased somewhat and she suffered less. She in- 
formed me that there was an exacerbation of fever every night, at 
which time the uneasiness over the abdomen was increased. The 
opening continued to increase in size for the succeeding four or five 
weeks, during which time we saw her several times. On the 6th of 
July a message came to us that she was "much worse," and on the 
following day Dr. Banks and myself visited her together. We found 
the aperture closed by granulations, and a considerable degree of ten- 
sion and heat about the part. She suffered us to make a tolerably free 
incision, by which about half an ounce of sanious bloody matter was 
discharged. 

We ascertained that the aperture was closed near the surface only, 
and that below the integuments it was increased in size. Tonic in- 
fusions and emollient poultices constituted the treatment, keeping 
the aperture freely open with lunar caustic. When we again saw her 
on the 14th, we could distinctly perceive, upon introducing the probe, 
that it came in contact with bone. From this time we could feel the 
bone very distinctly, whenever the probe was introduced. We had 
repeatedly pressed upon her the importance of resorting to the ope- 
ration in time, and we now urged her to consent to it at once, as she 
was evidently on the decline. There was a hectic glow upon her 
cheek, an irregular exacerbation of fever every day, and great unea- 
siness over the whole of the abdomen. Her strength had declined 
considerably within the preceding three weeks, and her stomach had 
lost its tone. She desired, however, that she might be allowed a short 
time yet to reflect upon it before she determined to submit to the ope- 
ration. She mentioned as a reason why she hesitated, that every in- 
dividual whom her husband or herself had consulted, was pf opinion 
that it would probably destroy her. 

At a subsequent visit we endeavoured to impress upon her mind 
the absolute necessity of having the bones removed before it was too 
late. She was now much emaciated, the hectic symptoms had increas- 
ed considerably, and she appeared to be sinking rapidly. Seeing now 
that unless the irritating cause was removed she must very speedily 
sink, she at length consented to submit to an operation, though her 
husband was opposed to it even on the day it was performed, and as 



Toy^s Case of Pregnancy, 37 

she has since informed me, every friend whom she consulted endea- 
voured to dissuade her from it. She displayed much firmness. 

We proceeded to remove the bones on the 12th of August, her 
husband, an old woman, Dr. Banks, and myself being the only per- 
sons present. The aperture had increased in size considerably, being 
about two lines in diameter at the surface. I made the first in- 
cision about four inches long, in the direction of the linea alba, 
commencing two inches above the umbilicus, and one inch to the 
right of it. This was continued through the parietes of the abdomen 
and uterus into the cavity of the latter, the incision in the uterus be- 
ing more than two inches in length. This incision I crossed in its 
centre, by another at right angles with it of equal length and depth. 
The top of the cranium was found presenting, the bones appearing to 
be firmly united. 

I attempted to introduce a pair of small obstetrical forceps, with 
the view of removing the head at once. This, however, was found to 
be impracticable without using more force than I judged prudent, as 
the uterus was firmly and rigidly contracted around it. I used there- 
fore, a pair of strong forceps from a pocket case, and with these suc- 
ceeded in detaching and removing the bones of the cranium separate- 
ly and successively^ all the other bones of the foetus remaining. We 
found that adhesive inflammation had united the uterus to the parietes 
of the abdomen for some distance around the opening, the diameter of 
the circle of adhesion was more than an inch. The operation occu- 
pied about fifteen minutes. After repeatedly washing the part, the 
edges of the wound were brought together, and dressed with adhesive 
plaster. Stitches were found unnecessary. Over this, pledgets of lint 
and a compress of old linen were applied, and a roller passed round 
the abdomen. Before the wound was dressed the lady expressed her- 
self entirely relieved from the uneasiness which the presence of the 
bones had so long occasioned. She complained of some pain about 
the uterus. 

On our visit the next day, she was in all respects doing well. The 
pain which she complained of the preceding day had continued for 
some hours, but she was now entirely easy, and expressed in 
strong terms the relief which she had felt since the removal of the 
bones. 

In six weeks she was entirely well, and had visited several of her 
neighbours. The opening which had existed previous to the operation 
was not entirely filled up, but the incisions united by the first inten- 
tion. 

I saw this lady in December last— she was then in fine health and 



38 Faust on Malaria. 

very fleshy. The catamenial discharge had returned and was now re- 
gular. 

This case could not have been one of extra-uterine conception, for 
the early history of the case together with the discharge of the soft 
parts and bones per vaginam, prove incontestibly that it was uterine, 
even if the operation had not demonstrated the fact. Neither can it be 
believed that there had been rupture of the uterus at any period dur- 
ing the progress of this case, for when the bones were removed they 
were firmly enclosed in the uterus, and there was no other opening 
but the passage externally, for which we think there is little difficulty 
in accounting. The pressure of the bones against the walls of the 
uterus, produced inflammation and suppuration, which, passing by 
continuity of surface to the parietes of the abdomen occasioned the 
aperture. The inflammation thus excited also produced adhesion be- 
tween the uterus and abdominal parietes, which union must still ex- 
ist — indeed, when I last examined her, the parietes of the abdomen 
were considerably drawn in by this attachment. 

Believing this case to be of considerable interest to the medical 
world, and besides, one of rare occurrence,* I have been induced to 
submit it for publication. 

Hampton, Elizabeth City County, Va. Feb. 1830. 



Art. III. Examination of the Nature and Effects of Malaria, and on 
the Pathology and Treatment of Malarial Fevers. By Edwin D. 
Faust, M. D. of Columbia, S. C. 

X HE subject to which we would call the attention of our readers, 
has been long patiently and ingeniously examined ; but the results of 
such examinations have not satisfied the philosophical minds of mo- 
dern physicians. The importance of the subject is every where known, 
and has excited, in all enlightened countries, a spirit of inquiry, 
which will finally result in successful discovery, but which has not yet 
procured us that kind of knowledge, on which alone, practical con- 
clusions can be safely founded. The causes which have retarded the 

* The only case I have met with at all similar to the foregoing, is one re- 
corded by Dr. Miiller, and noticed in the number of the American Journal of the 
Medical Sciences, for August, 1829. Owing to some accident, this number of 
the Journal did not reach me until some weeks after the removal of the bones 
in this case. In Dr. M.*s case the foetus was expelled at the umbilicus by thq 
natural efforts of the uterus. 



Faust on Malaria, 29 

progress of discovery in this most interesting department of medical 
science, are probably numerous, and it would be a difficult task to 
detect them all. In some cases, the views of observers have been too 
limited, as regards the kinds of knowledge employed in their re- 
searches, or the number and value of the facts from which they have 
formed their opinions. Others have been misled by attaching them- 
selves to some favourite hypothesis, neglecting all facts not easily re- 
concileable with their doctrine, and magnifying, in their own con- 
ceits, all those from which they have expected support. 

In a paper, the object of which is to ascertain truth as it is, and not 
to establish a merely ingenious hypothesis, we shall attempt to re- 
lease ourselves from the influence of our own prejudices, to examine 
candidly some of the doctrines concerning the nature and influence 
of malaria, to show in what points they are deficient, and to explain 
those views which appear to us most consistent with the phenomena 
which have been observed, and most likely to lead to sound practical 
conclusions. It will be seen that the elementary views on which our 
doctrine is based are not new; but that those elements have been 
sometimes examined in a new spirit, and have been placed in new 
relations with one another. From this, we hope to offer definite ideas 
on the present subject, and to lay the foundation for fixed principles 
on collateral questions. 

It seems to be pretty well determined, that the production of that 
volatile poison of which we are treating, depends, always, upon the 
co-existence of warmth, moisture, and decaying vegetable matter. In 
those cases in which remittent and intermittent fevers occur in dis- 
tricts not plainly showing the sources of malaria, we may always 
conclude that there is a sub-soil which prevents the percolation of 
water, or some other source of an analogous nature.* This source 
has been known for many centuries; and, as Dr. Caldwell remarks, 
is evidently referred to by Homer.I In Lucretius, also, we have 
the influence of an atmosphere poisoned by malaria, forcibly set forth. $ 
It might be contended that these cases referred to a cause different 
from that of remittent and intermittent fever, because, in both in- 
stances, domestic animals are said to have suffered, and in the for- 
mer they are made to precede man in the catastrophe. We are yet, 
however, to learn, whether lyssa and other epidemic and contagious 
diseases among domestic animals, do not result from the influence of 

* First American Edition of Gregory's Theory and Practice, vol. 1, p. 120. 
t Illiad, Book I. line 43. 

+ De Rer. Nat. Liber VI. 1217; or the Lucrece de Pongerville, Tom. 2, p. 
410; for a different version, see Good's Study of Medicine, 1825, Vol. 2, p. 49. 



40 Faust on Malaria. 

malaria, acting upon a peculiar and temporary state of the system of 
these animals. A remarkable case in point is detailed by the eminent 
Larrey, in his observations on a violent inflammatory fever which 
occurred among the cows and oxen, during the campaign of Italy, 
aifecting also the health of the inhabitants, and which dissection show- 
ed to be an intense gastro-enteritis. Speaking of the causes of this 
epidemic, he says, " Les renseignemens que je recueillie aupresdes 
habitans, les recherches aux quelles je me livrai, m'assurerent que 
Pepizootie reconnaissait, pour principales causes, la mauvaise qua- 
lite des fourages, Petat marecageux des paturages, la chaleur exces- 
sive et prolongee qui avait succede tout-a-coup a un printemps plu- 
vieux et orageux. Les pluies d'orage avaient considerablement grossi 
les torrensjles rivieres, et en avaient cause le debordement: une par- 
tie de ces eaux, apres avoir nui aux recoltes, etait rest^e en stagna- 
tion dans les lieux bas et enfonces, ce qui avait forme autant de ma- 
recages."* 

To the moderns, however, we owe our present views on the sub- 
ject, and Lancisi appears to be the original writer.t For the esta- 
blishment of our views, it will be necessary to bring before our rea- 
ders, some of the most important characters of malaria, as determin- 
ed by the best authorities, and to show that these characters are in- 
consistent with some of the doctrines which have been or may be ad- 
vanced. 

The evidence offered by Dr. Macculloch, to show that malaria 
adheres to solids, is, we think, by no means conclusive; but we allow 
the fact, and shall show that even this, if granted, is not fatal to our 
views.:}: 

It obeys the motions of the atmosphere, and is generally, if not al- 
ways, combined with water, in the form of mist. § 

The rays of the sun disperse it.l| 

Fire and smoke prevent its effects; not as Macculloch suggests in 
pages 292 and 293, but as we shall hereafter explain, and as he 
seems, from page 285, to have faintly conceived. 

It causes fever. The varieties in the kinds of fever produced by 
the malaria of different situations, do not show any difference in the 

' * Memolres de Chirurgie Militaire, torn. 1, p. 165. 

■j- De noxiis paludam effluviis, l/lf, as quoted by Gregory, vol. 1, p. 118, 
first American edition. 

t Malaria: an Essay on the Production and Propagation of this Poison, Sec 
London, 1827, p. 267 and 268. 

§ Macculloch, p. 259 and 311. 

B Macculloch, p. 276, or Caldwell's Translation of Alibert, 1807, p. 172. 



Faust on Malaria. 41 

malaria; at least they do not demonstrate it; for the relative propor- 
tions of moisture and gas, the climate, season, constitution and mode 
of life of the patients, together with other circumstances, will, per- 
haps, explain all these phenomena. 

The poison has been supposed to be intercepted by a gauze veil; 
but of this there is no satisfactory evidence.* 

It follows currents of air; occupying the lower regions of the at- 
mosphere, and not rising to the height of a few hundred feet, unless 
raised by a strong breeze, or by the sun.t 

It is supposed to be intercepted by groves in which the foliage is 
thick. ± Houses are thought to have the same effect; that side of a 
street, nearest a marsh, being usually considered most sickly. § 

It acts most powerfully before the rising and after the setting of the 
sun; the presence of which disperses or decomposes it, or both.|| 

Malaria may be considered as an uncombined gas,^ as the vapour 
of a volatile solid or liquid, as animal cular,"^* or as a gas combined 
with water. 

Its characters differ widely from those of uncombined gases. It is 
known to every chemist, that whenever any gas is allowed to escape 
into the air, however great may be its specific gravity, it speedily 
and uniformly diffuses itself through the mass of air, not occupying 
any particular region. tt This is the case, even with gases which do 
not combine; as is seen in mixing carbonic acid and hydrogen gases; 
the mixture remaining uniform, notwithstanding the great difference 
in the specific gravities of the two substances.^: The proportion of 
carbonic acid in the atmosphere of mountains, is the same as in that 
of vallies.§§ It will follow then, that, as gases, in an uncombined 
state, mingle, in opposition to the laws of gravity, while malaria oc- 
cupies the lower strata of the atmosphere, and is with difficulty dif- 

* Macculloch, p. 299. 

f Caldwell's Translation of Alibert on Malignant Intermittents, p. 175, or 
Macculloch, p. 265. 

\ Macculloch, p. 247, 252. 

§ Baglivi, Opera Omnia, p. 157, 158, as quoted in Bancroft's Treatise on 
Yellow Fever, p. 165. 

a Caldwell's Alibert, p. 172, 173, or Macculloch, p. 276. 

\ Volta's idea; see Macculloch, p. 421. 

** American Quarterly Review, for Dec. 1828, p. 303. 

It Thomson's Chemistry, 1818, Vol. III. p. 34; Webster's Manual of Chemis- 
try, 1826, p. 165. 

\% Thomson, Vol. HI. p. 33; carbonic acid is 22 times heavier than hydrogen. 

§§ Turner's Chemistry, iirst Amer. edit. 1828, p. 146. 

No. XI .—May, 1830. 5 



42 Faust on Malaria. 

fused, unless by strong winds, malaria cannot be consistently viewed 
as an uncombined gas. 

The vapours of very volatile solids and liquids, as camphor, musk, 
ether, &c. follow the same law of uniform diffusion as gases, and have 
therefore no stronger claim to be considered as constituting malaria, 
than the latter class of substances. 

The doctrine of the animalcular nature of malaria, which is of an- 
cient origin, and has met with support from some more modern wri- 
ters, does not appear to us to present stronger evidences in its favour 
than the former hypotheses. It merits, however, a particular consi- 
deration. The localities from which malaria emanates, are such as 
maybe expected to generate animalculse; but the same situations are 
the invariable and inexhaustible sources of carburetted hydrogen, 
carbonic acid, and other gases. The argument of co-existence, there- 
fore, as applied to the defence of this doctrine, goes for nothing; be- 
ing equally applicable to other agents, of well known deleterious cha- 
racter. But allowing animalculee to be produced in marshy situa- 
tions, it must be remembered that they are generated in water, or in 
contact with moist soil, or vegetable matter, to which, on account of 
their extreme minuteness, they must be closely attached by this 
moisture. Under these circumstances, it will be mechanically impos- 
sible for the atmosphere to remove them from the places in which 
they w^ere formed; and they must, of course, die and decay, without 
ever mingling with the air. This very obvious and simple objection 
is fatal to the hypothesis, as it stands at present, and the supporters 
of the doctrine will be driven to the necessity of endowing the ani- 
mal culae with wings; a position which could not be reasonably as- 
sumed. 

Malaria remains near the ground, and obeys the lower currents of 
air; but solids so minute and light as to float in a calm atmosphere 
will not remain near the surface, but will mingle with the mass of 
air, in the same way as uncombined gases with one another, from 
the simple facts that no portion of the atmosphere ever retains its 
position for two minutes together, and that these solids obey the 
slightest possible impulse. Any current of air sufficient to detach 
animalculse from even a dry soil, must disperse them so as to pre- 
vent their deleterious influence, while a very weak impulse, such as 
propagates malaria, must fail to raise them from the moist matter to 
which they adhere. The radiated heat of a fire, smoke, and proba- 
bly other chemical agents, neutralize the effects of malaria; in what 
way we shall consider hereafter. But it is well known that the 
lower classes of animals resist, in a surprising degree, the want of 



Faust on Malaria. 43 

pure air, and the presence of deleterious matter, such as the irrespi- 
rable gases, even in a concentrated state; and still more in the very 
diluted form here supposed, in which these agents must be harmless 
to insects. 

Malaria seems to be interrupted by a row of houses, so that fever 
is more common on the side of a street nearest a marsh, than on the 
opposite side. But if malaria consist of air holding in suspension 
animalculee, it is evident that the poison would have such free access 
to the more remote side, through the spaces between the houses, and 
by the cross streets, as well as by other accidental and various ave- 
nues as to infect completely both sides, and prevent the occurrence 
of any perceptible difference. We shall show hereafter, that the 
same objection does not apply to our views. 

Malaria is dispersed, if not decomposed, by the sun; but we can- 
not suppose that animalculge are in any way affected by a tempera- 
ture high enough to support all animal life, yet not even so high as 
that of the places in which they were generated. The moist soil in 
which animalcules were produced, will always be more heated by the 
rays of the sun, than the atmosphere, or minute bodies floating in the 
open space to which the wind has free access. 

All these facts seem to us inconsistent with the hypotliesis now un- 
der consideration; and we shall violate the principles of philosopliy 
if we reject opinions founded on indisputable facts, and supported by 
the strongest probabilities, for others founded on a supposed existence 
of animals not proved to exist, not appreciated by our senses, and 
not proved, even granting their existence, to possess the properties 
attributed to them. The most malignant fever may be excited by a 
few hours exposure to a very concentrated malaria. How then can 
it be conceived, that the atmosphere should be so loaded with ani- 
malculae, as to act violently and rapidly on the system, producing 
the most intense inflammations and dangerous congestions of the in- 
ternal organs, and yet, the animals so fatally abundant remain invi- 
sible, intangible, tasteless, and inodorous: it is impossible. If the 
animalculse be so extremely numerous as in these cases they must be, 
then they will necessarily be visibly accumulated on the skin, and on 
surrounding substances; the mucous membrane of the lungs and nose 
will detain them in such quantity as to excite cough, if not complete 
bronchitis. Nothing of this kind occurs. The matter of malaria 
works its fatal ravages invisible as air. The living fibre shrinks from 
its touch, and the blood seeks refuge, as it were, in the vital organs; 
but no external trace is left after its action, or perceived during its 
application, except the slight contraction of the cutaneous fibre, and 



44 Faust on Malaria, 

a diminished activity of the capillary circulation; a condition pre- 
cisely opposite to the effects of all known insects. There is no ex- 
ample in nature, of the production of fever from the poison of any 
insect externally applied, vi^ithout previous acute inflammation of the 
skin. In all these cases the external application of the poison re- 
sults in a direct external irritation, of which the gastro-enteritis, 
(fever,) is a consequence. The whole series of phenomena, in ^he 
case of malaria, is opposite. If there he any cutaneous irritation^ it 
is slight and evanescent, and it is only when the vital actions of the 
surface languish, that we find the development of constitutional dis- 
ease. * 

Are we told that the animalculse are swallowed with the saliva? 
It is a frail argument, because the fact is not proved; and because, 
if the saliva could be so saturated with animalculse as to become poi- 
sonous, then would the poison itself be visible, and change the pro- 
perties of the fluid: this has not been seen. In another point of view, 
the assertion is of no value. In passing through the towns of Italy, 
the traveller is especially cautioned to sleep as little as possible, in the 
malarial districts, as sleep is found to be favourable to the reception 
of fever in such situations. The reader will remember, unfortu- 
nately for the animalcular doctrine, that during sleep the secretion 
of saliva is diminished,! and less is swallowed than in the waking 
state. On this ground sleep might be considered prudent in persons 
exposed to malaria; but the contrary is the case. We must not, too, 
overlook the fact, that during sleep the mouth is usually closed, and 
the air passes to the lungs without coming in contact with the saliva, 
and therefore without contaminating it. The well established fact 
above alluded to, is then inconsistent with the hypothesis under con- 
sideration. Let us see whether it does not lend support to the 
views which we have adopted. It is known to every physiologist, 
that during sleep, the cutaneous circulation is languid,:j: while there 
is an accumulation of blood in the internal organs; indeed, that the 
latter state is one of the first steps to the ordinary occurrence of 
sleep. § This determination predisposes, so long as it continues, to 
internal inflammation and congestion; and this predisposition is the 

* The influence of malaria in depressing the vitality of the surface, is illus- 
trated by Dr. Daniell, of Savannah, in his work on fever; but this ingenious 
author has erred in supposing the digestive surface to partake of the cutaneous 
atony. Those who have heard the learned and valuable lectures of Dr. Ged- 
dings of Charleston, will recognise the above doctrine. 

f Broussais's Physiology, 1826, p. 156. 

±0p. Cit. p. 157. §0p. Cit. p. 151, 154. 



Faust on Malaria. 45 

more easily converted into actual disease, because the actions of the 
skin are, in this languid state, more readily suspended by the mala- 
ria, than in the more active condition of wakefulness.* We have 
thus a satisfactory rationale of the greater liability to fever in the one 
state than in the other. 

Nor does the prevalence of insects always correspond with that of 
malaria. The abundance of all kinds of insects in Columbia, for 
some months past, has been remarkable, especially of the smaller 
species, near the marshes surrounding the town. The mosquitoes 
did not appear as early as usual, but have been abundant for some 
time past. Yet among this host of insects none of the poisonous ani- 
malculse have appeared, and the good health of not only Columbia, 
but also of the greater portion of the statetis now, (November 1st,) and 
has been for some time almost unparalleled. 

Such is the substance of the objections against the doctrines above 
discussed, which now occur to us. We believe all these doctrines 
to be inconsistent with well known facts, and we have endeavoured 
to point out some of those inconsistencies. 

We shall now go on to develope our own opinions concerning the 
nature of malaria; to show that it consists of a chemical combination 
of carburetted hydrogen and water, which chemists have failed to de- 
tect, on account of the imperfections of their tests. 

In marshes, and in pools of standing water resting upon mixtures 
of mud and dead vegetable matter, large quantities of light carbu- 
retted hydrogen are formed and disengaged during the warm months. 
By stirring the mud at the bottom of the stagnant water, bubbles of 
gas escape, and may be received in inverted jars, floating on the sur- 
face, and furnished with funnels of oiled paper, for the more easy 
reception of the gas.| When thus obtained, it is mixed with about 
J^ of carbonic acid, and about the same quantity of nitrogen. § This 
mixture does not materially affect its properties, and the carbonic 
acid may be removed by washing it with lime water. 

Light carburetted hydrogen is tasteless, colourless, and inodorous. || 
It supports neither life nor combustion. ^ When mixed with com- 
mon air, in proper proportion, it forms an explosive mixture; but if the 
gas exceed the one-sixth, or be less than the one-twelfth of the whole, the 
compound ceases to be explosive. When mixed with rather more than 
one volume of oxygen, it is explosive; but not so if the oxygen amount 

* Op. Cit. p. 157. t A few of the upper districts excepted. 

t Thomson's System, Vol. I. p. 209. § Turner's Chemistry, 1828, p. 191. 
a Thomson's System, Vol. I. p. 210. 1 Turner's Chemistry, p. 191. 

5* 



46 Faust on Malaria. 

to 2.25 volumes.* When mixed with chlorine, both gases being 
dry, no action occurs, but if the gases contain water, muriatic acid 
is formed, and either carbonic acid or carbonic oxide, according to 
the proportions, is set free.t Its specific gravity is 8, hydrogen be- 
ing 1.% It is soluble in sixty times its volume of water,§ and ihis 
property has an important relation to the subject before us, as indi- 
cating that it is combined with the water of fogs, and it is even pro- 
bable that in this rarefied form, in which a given quantity of water 
exposes so large a surface and is so minutely divided, a larger quan- 
tity of gas will be detained, and the union will be more strict. Its 
combination with the aqueous vapour will explain the fact that it does 
not rapidly disperse itself in the atmosphere, as is the case with un- 
combined gases, but rather occupies the lower regions of the atmo- 
sphere, until the sun raises it along with the vapour into the upper 
region. 

According to Dr. Beddoes, the blood and muscles of animals killed 
by confinement in this gas haye a red colour, less distinct than that 
produced by oxygen, but very different from the dark colour exhi- 
bited by animals killed by drowning or carbonic acid.|| There is 
much obscurity in the reddening of blood by this gas, and there 
seems to be no error, as Dr. Beddoes speaks very positively of the 
facts, and mentions some decisive experiments. 

The following statem.ent of Sir H. Davy, shows the powerful de- 
pressing influence of the gas, when received into the lungs. It will 
be observed in this case, as in those quoted from Dr. Beddoes, that 
the gas was obtained from steam and clmrcoal^ that it possessed, 
when newly made, a strong odour, and that being necessarily impure, 
it affords only an approximation to the effects of the gas obtained 
from stagnant water. 

" For this purpose I introduced into a silk bag" four quarts of gas, nearly 
pure, v/hicli was carefully produced from the decomposition of water by char- 
coal, an hour before, and which had a very strong- and disagreeable smell. 

*' My friend, Mr. James Tobin, Jr. being present, after a forced exhaustion of 
my lungs, the nose being accurately closed, I made three inspirations and ex- 
pirations of the hydro-carbonate. The first inspiration produced a sort of numb- 
ness and loss of feeling in the chest and about the pectoral muscles. After the 
second inspiration, I lost all power of perceiving external things, and had no 
distinct sensation, except a terrible oppression on the chest. During the third 

* Thomson, Vol. I. p. 210. f Turner, p. 192. 

^ Macneven's Brande, 1826, p. 140. § Turner, p. 191. 

II Beddoes on Air; the various parts are so badly arranged that we cannot 
specify pages. 



Faust on Malaria. 47 

expiration this feeling* disappeared; I seemed sinking into annihilation, and had 
just power enough to drop the mouth-piece from my unclosed lips. A short 
interval must have passed, during which I respired common air, before the ob- 
jects about me were distinguishable. On recollecting myself, I faintly articu- 
lated, * I do not think I shall die.' Putting my finger on the wrist, I found my 
pulse thread-like, and beating with excessive quickness. 

" In less than a minute I was able to walk, and the painful oppression on the 
chest directed me to the open air. 

"After making a few steps, which carried me to the garden, my head be- 
came giddy, my knees trembled, and I had just sufficient voluntary power to 
throw myself on the grass. Here the painful feeling of the chest increased 
with such violence as to threaten suffocation. At this moment I asked for some 
nitrous oxide. Mr. Dwyer brought me a mixture of oxygen and nitrous oxide, 
I breathed this for a minute, and believed myself relieved. In five minutes the 
painful feelings began gradually to diminish. In an hour they had nearly dis- 
appeared, and I felt only excessive weakness, and a slight swimming of the 
head. My voice was very feeble and indistinct. This was at two o'clock in 
the afternoon. 

"I afterwards walked slowly for about half an hour, with Mr. Tobin, Jr. and 
on my return was so much stronger and better as to believe that the effects of 
the gas had disappeared, though my pulse was 120 and very feeble. I conti- 
nued without pain for near three-quarters of an hour, when the giddiness re- 
turned* with such violence as to oblige me to lie on the bed; it was accompa- 
nied with nausea, loss of memory, and deficient sensation. In about an hour 
and a half, the giddiness went off, and was succeeded by an excruciating pain 
in the forehead and between the eyes, with transient pains in the chest and 
extremities. 

** Towards night these affections gradually diminished. At ten no disagree- 
able feeling except weakness remained. I slept sound, and awoke in the 
morning very feeble and very hungry. No recurrence of the symptoms took 
place, and I had nearly recovered my strength by the evening."! 

The following cases are mentioned, in other words, bj Dr. Bed- 
does: Mr. Greenwood had used the carburetted hydrogen for about 
two weeks, in doses of from two pints to five quarts daily, with lit- 
tle ett'ect. The gas w^as diluted, of course. On the 5th of October 
he breathed four quarts, diluted 5 it is not stated to what amount. 
Ten minutes after this, there was a sense of numbness in the fore- 
head, with heaviness of the eyelids, followed by extreme weakness, 
and a sense of vacuity in the abdomen. He made an effort to walk 
a few feet, but was unable to do so. He soon lost all consciousness, 
for some time, the length of which he could not ascertain. During 

* A singular tendency to an intermittent type. 

t Sir H. Davy's Researches, Chemical and Philosophical; chiefly concerning 
nitrous oxide or dephlogisticated nitrous air, and its respiration. London, 
1800, p. 468. 



48 Faust on Malaria, 

this time, there was an involuntary discharge of urine; after which, 
there was paleness of the face, blue lips, fainting, with extreme weak- 
ness for some hours. 

A person standing in a current of air while about a cubic foot of 
the gas was set free, felt, as it passed him, very sensible depression, 
with vertigo. Another person was thrown into a state of complete 
syncope, by standing near a tube from which the gas issued for a 
short time. 

The gas prepared from steam and charcoal, is observed to become 
less active when kept for a few days.* As it is not liable to spon- 
taneous decomposition, this loss of activity is not very easily explain- 
ed. We cannot imagine that the intelligent practitioners who have 
prescribed it, would neglect to free it carefully from carbonic acid. 
As above prepared, it will usually contain some pure hydrogen and 
carbonic oxide, varying in proportion according to the degree of heat,t 
yet, as these gases suffer no change on standing, their presence does 
not explain the phenomenon. Is it not possible that the gas, when 
newly made, contains a greater quantity of water, than after stand- 
for some time, and that this water enables it to act more powerfully 
on the system? The subject is at least worth a serious examination. 
In the process for preparing the gas, it is brought in contact with the 
heated vapour of water; of course it will unite, under these circum- 
stances, with a considerable quantity of water, a part of which it 
will deposite on standing. An analogous deposition is often observed 
by chemists, in saturated solutions which have remained perfectly 
still for some time. In such cases, crystals subside without the in- 
fluence of temperature.! The subject is obscure, but we are not 
aware of any other principle on which the fact can be explained. 

From the physiological effects of carburetted hydrogen, as above 
stated, it cannot fail to be observed that it has a powerful influence 
in determining congestions of the vital organs, with prostration of the 
muscular powers, and that it leaves, even when applied for but a mo- 
ment, effects of a striking and by no means evanescent character. Per- 
haps, indeed, its power of producing internal accumulation of blood 
will afford the only possible explanation of its effect of reddening the 
muscles of animals destroyed by it, for it is evident that the gas itself 
cannot decarbonize the blood. This, however, is not satisfactory to 



* Beddoes on Air. f Thomson's System, Vol. I. p. 210. 

± Thus, on mixing- solutions of phosphate of soda and sulphate of mag-nesia, 
no immediate effect follows; but after some hours the phosphate of magnesia is 
deposited in crystals. (Thomson's System, Vol. IT. p. 377.) 



Faust on Malaria, 49 

ourselves, for the venous blood is redder than in cases of death from 
carbonic acid 5 and it would thus seem, that the gas interrupts those 
changes in the parenchymatous structure of the organs by which the 
arterial fluid is carbonized. The subject, we again confess, is in- 
volved in much mystery. 

The physiological physician will recognise, in the fulness of the 
head and heaviness of the eyes, the lividity of the lips and syncope, 
the vertigo, rapid, thread-like pulse, dizziness, nausea, head-ache, 
tremor, confusion of mind, pains of the extremities, and exces- 
sive muscular debility, many of the most essential symptoms of those 
gastro-enterites, more or less acute, simple or complicated, which 
the universal observation of mankind has determined to result from 
the impression of malaria. To the ontologist, to whom the supposed 
idiopathic fevers are known as an assemblage of symptoms only, the 
resemblance may not be sufficiently perfect. For differences in the 
degree and order of symptoms, we would refer him to the minute de- 
tail of any two cases of severe fever, and more particularly to Brous- 
sais's case of acute and fatal but apyrectic gastro-enteritis. * To the 
true pathologist, however, who sees diseases not in the pages of the 
nosologists only, but in the several organs of the body, the similarity 
between the effects of carburetted hydrogen and malaria, will be 
sufficiently evident, and he will not doubt that an atmosphere conta- 
minated by the presence of this gas, can produce effects identical 
with those observed in fevers. 

It has been asserted, that if an atmosphere contain carburetted hy- 
drogen gas, the chemistry of the present day is adequate to its detec- 
tion. This is undoubtedly true, with respect to mixtures containing 
a certain proportion of the gas in question; but let us see how it will 
apply to the examination of malaria. The quantity of carburetted hy- 
drogen contained in any atmosphere, and the proportion requisite for 
the production of the usual effects, may be fairly considered as very 
small, probably less than the thousandth part of the whole mass. If, 
however, it be allowed to constitute so large a proportion as the five- 
hundredth, it will not, even then, be detected, by any means yet ap- 
plied to the examination of the atmosphere of marshes; and therefore 
all the chemical experiments hitherto instituted on the subject, may 
be considered as having no weight in the present discussion. No ■ 
axiom in mathematics can be more self-evident, than that carburet- 
ted hydrogen must exist in the atmosphere of places in which it is 
constantly generated in large quantities; yet the chemists have not 

* Histoire des Phlegmasies Chroniques, Tome II. p. 479o 



50 / Faust on Malaria. 

detected it. Hence, we see, that whether the gas in question, be ma- 
laria, or not, we must look for its detection to a more refined che- 
mistry than has ever been applied to the examination of this subject. 
Will the chemist attempt to convert the gas into water and carbonic 
acid, by the electric spark? The properties of the gas will instruct 
him, that in the diluted form of malaria, the change cannot be eifect- 
ed, by even the most persevering application of this agent. And if 
he could succeed in effecting the change, the quantity of water and 
carbonic acid developed would be so very minute, that they would 
not be appreciable by our tests, unless we should operate on quanti- 
ties of air larger than our largest receivers would contain, and far 
greater than any yet examined. 

Will it be attempted to decompose it by chlorine? It will be re- 
membered, that the gases, if dry, do not even when concentrated, 
act on one another. But suppose them to be moist; it is extremely 
probable, though not verified by actual experiment, that when so 
largely diluted, no action will occur, and no muriatic acid be libera- 
ted. Indeed this probability amounts almost to certainty, when we 
reflect that even in a concentrated state the action is not very ener- 
getic. Allow, however, that in this diluted state, the decomposition 
should occur; the small portion of muriatic acid formed, being dif- 
fused through a large quantity of air, and mixed with chlorine, our 
tests will not be able to establish its presence; because some uncom- 
bined chlorine will necessarily be present, and the tests of muriatic 
acid are the same as those of chlorine. And even were it possible to 
establish the presence of a little muriatic acid, no accurate and cautious 
chemist would feel satisfied that this did not result from the decom- 
position of aqueous vapour. Nor will it be possible to remove the 
oxygen and nitrogen of the air under examination, so as to leave the 
matter of malaria alone; for if we absorb the oxygen by phosphorus, 
still the nitrogen must remain and mask the poison. When we re- 
flect on all these difficulties, very nearly if not entirely insuperable 
by the most effectual application of the improved modes of analysis 
invented since any careful experiments have been instituted on this 
question, the impartial chemist must confess, that the evidence af- 
forded by his science cannot as yet be entitled to much consideration; 
nor must the present writer be considered among those most ready 
to make this concession. After all, we do not despair of the assist- 
ance of chemistry in this important and interesting department of 
science; and we are inclined to believe, that the quantity of poison- 
ous matter sometimes present in the atmosphere of the worst places, 
in the worst seasons, will be too great to escape the present accurate 



Faust on Malaria. 51 

tests, under the skilful direction of a Thenard, a Hare, or a Sil- 
LiMAN. A fortunate combination of circumstances alone, however, 
can ever ensure success. 

' We proceed to some further proofs, that our doctrine is not incon- 
sistent with those properties of malaria which have the most impor- 
tant relation with our subject, and which have been already stated. 
It must be kept in mind by the reader, that, in obedience to a gene- 
ral law of affinity, water, in the minutely divided form of fog, or more 
perfect vapour, will unite more freely and easily with carburetted 
hydrogen, than in its liquid states but that, in this case, a certain 
point of rarefaction will reverse the law. 

We stated that the evidence on which malaria was supposed to at- 
tach itself to solid bodies, was not altogether satisfactory; yet, al- 
lowing it to possess this property, it forms no objection to our views; 
for the observation of every day teaches us, that the watery vapour 
of the atmosphere is constantly deposited on the various solids with 
which it meets. This is especially the case with fogs, well known to 
be the most usual, or even the constant vehicle of the deleterious 
agent. Hence we might reasonably expect considerable danger from 
fogs thus impregnated; and observation of facts justifies the opinion. 

Malaria obeys the motions of the atmosphere; occupying, however, 
the lower positions, and not rising to the height of a few hundred 
feet, unless raised by pretty strong currents of wind, or by the influ- 
ence of the sun. This corresponds with the vapour in question; and 
we have already shown that it is inconsistent with any other suppo- 
sition. Every one has seen fogs of various density pass over exten- 
sive tracts of country, without rising above the trees; and where they 
liave free access to any inhabited situation, they have produced fever. 
Hence the danger of even passing through the lower country of our 
state, in which the mass of decomposing matter, and therefore the 
source of carburetted hydrogen, is immense, and the country be- 
ing low, and the winds obstructed by innumerable forests, the poison 
accumulates to an alarming degree, and produces the most malignant 
gastro-enterites. 

It is dispersed by the rays of the sun. We have already shown, 
that this property is not possessed by any of the bodies supposed by 
others to constitute malaria; but every observer will recognise a very 
familiar property of aqueous vapour. However abundant the fog may 
be, it is always dispersed soon after sunrise. The vapour becomes 
rarefied, and rises into the higher regions of the atmosphere. Hence 
we may expect fever even on high mountains, when there is an abun- 
dant source of malaria in the valley; because the contaminated va- 



52 Faust on Malaria. 

pour, when rarefied to a certain degree, will rise until the atmosphere 
becomes too rare to support it, and must then remain stationary un- 
til still more expanded. This does occur in various instances; and if 
it be inquired why it does not happen in every case, we find an ex- 
planation in the facts, that the population of such situations is not 
often great enough to render them remarkable, and the winds are 
usually strong enough, in high regions, to disperse the contaminated 
vapour, before it can produce its accustomed effects. To this we may 
add, that it is highly probable, nay even certain, that the rarefaction 
of the vapour is often such as to allow even the water to be uniformly 
dispersed, and the gas to be set free, and come under the laws of 
uncombined gases. The properties of fogs correspond so precisely 
with those of malaria, in this respect, that the coincidence might very 
naturally suggest the probability of the whole of our views. 

Fire and smoke prevent the effects of malaria. Dr. Macculloch 
has suggested that this may occur from the ventilation produced by 
fire, and the substitution of pure air in place of the contaminated at- 
mosphere. It must be evident, however, that in all such cases, the fire 
only substitutes one portion of impure air for another 5 and thus, so 
far as concerns its ventilating effect, is probably rather a disadvan- 
tage than otherwise. As the beams of the sun disperse malaria, so 
also will fire have the same effect. Under the influence of heat the 
moisture is expanded, and thus displaced by heavier air. There is 
no doubt, too, that heat disengages the gas from the water, and thus 
renders it subject to the laws which govern the mixture of uncombin- 
ed gases. The effect of heat is, then, precisely what our views would 
lead us to expect, so far as concerns its effects on malaria. It must 
be recollected too, that heat keeps up the activity of the cutaneous 
circulation; an effect in which it directly opposes moisture in a simple 
state, or in the contaminated form of malaria. The skin, too, being 
preoccupied by an impression, is less calculated to receive that on 
which the disease depends. This is a consideration of importance; 
as we daily apply it to the cure of intermittent gastro-enteritis, (in- 
termittent fever.) As heated air usually accompanies smoke, the 
same observations will apply to the influence of that agent. In ad- 
dition to this, however, we must consider, that the acid and other 
constituents of smoke, may, perhaps, by uniting with the aqueous 
particles, disengage the gas to which the evil effects are attributable. 
This, it must be allowed, has not been absolutely demonstrated. 
The union of smoke with the matter of malaria, must, however, exert 
a considerable influence, in modi^ing not only the impression made 
on the surface, but also the condition of the surface itself, and conse- 



Faufet on Malaria. ^^^ 

qtiently its capacity for receiving the peculiar morbid change on which 
depends the subsequent development of gastro-enteritis. These causes 
will, we think, be quite sufficient to account for the effects; and the 
phenomena only confirm the doctrine which we advocate, while they 
invalidate all others. 

The interception of malaria by groves, has been quite a mystery to 
the theorists on this subject, and it is indeed a circumstance not free 
from obscurity. The animalcular doctrine fails here completely; be- 
cause animalculas are not found on the trees as they should be. Their 
extreme minuteness is no excuse, because every visible body consists 
of an immense number of invisible particles. This much however is 
certain; i. e. that the greater part of the poison comes in actual con- 
tact with the foliage, and is detained or decomposed by it. Now it is 
a fact familiar to every one, that fogs, in passing through groves, are 
deposited upon the trees in great quantity; even so as to fall in 
showers upon the least agitation. The malaria being thus detained, 
partly penetrates into the leaves and bark, and is partly dispersed by 
the sun. It is probable, also, that the carburetted hydrogen accom- 
panying the water, is absorbed by the trees, and being decomposed, 
contributes to their growth, in the same way as carbonic acid. This 
view appears satisfactory to us, so far as concerns the action of ve- 
getables. Another explanation is necessary in the case of ranges of 
houses. Allowing the truth of any one of the doctrines of malaria, it 
must be evident, that the mere mechanical opposition of one side of 
a street, can never secure the other side, as the cr4ss-streets and 
other openings, always allow a circulation of air sufficient to produce 
disease under such circumstances. In Columbia, the streets are one 
hundred feet wide, and thinly built, with cross streets of the same 
width. Here then is free access to animalcule; yet fever is much 
more common on the side next the river. We have already attempt- 
ed to account for the influence of smoke and heat; and it will readily 
occur to the reader, that malaria, after passing the row of houses 
nearest to a marsh, and depositing a good deal of its substance on the 
walls of the houses, must encounter, on entering the street, a greater 
or less quantity of smoke, as well as other accidental and various va- 
pours, some of which may perhaps have some chemical action on it. 
This last part of the proposition, we do not state as decided. In ad- 
dition to this, it will mingle with warm air^ and be heated and rare- 
fied by the caloric passing from pavements and houses, which, by 
reason of the close situation and constant reflection of heat, have be- 
come very warm. We can well conceive, that the combined effects 
of these causes may diminish the activity of the poison; though, it 

No. XL— May, 1830. 6 



54 Paust on Malaria. 

must be remembered, that this diminution is limited. If the reader 
think these causes insufficient, let him consider that the mere mecha- 
nical obstacle is not here, as in a grove, sufficiently extensive to ac- 
count for the effect, and that some cause must exist within the street 
itself; let him then review what we have already said of the action of 
heat and smoke, and thence draw his conclusion. 

Malaria acts most powerfully before the rising or after the setting 
of the sun. It is well known that the aqueous vehicle of the carburet- 
ted hydrogen is dispersed, if not separated from the poison by the 
beams of the sun. No other doctrine of malaria can be reconciled 
with the fact. 

Aqueous vapour more or less dense, and united with carburetted 
h3"drogen, as the vapour of marshes must be, being repeatedly ap- 
plied to the skin and received into the lungs, will depress the capil- 
lary circulation of both surfaces. Whether this effect is the result of 
a directly debilitating influence, or whether the vessels lose their 
tone by exhaustion from repeated or continued excitement, need not 
be discussed here. Whenever the malaria is accompanied with a 
chilly night air, the certainty and violence of the resulting disease 
are greater^* because there is then a double cause for the suspension 
of capillary action. If the constitution of an individual be worn down 
and the actions of the vital organs deteriorated by previous debauch 
or disease, this interruption of the cutaneous functions will be more 
easily produced; and as, in such persons, the internal organs have ge- 
nerally been*^ prey to chronic irritation, the new inflammations are 
more to be dreaded. 

If the quantity of gas in the atmosphere be moderate, the fever re- 
sulting from its influence will probably be intermittent or remittent; 
otherwise, it may assume a continued form. Physiologists have at- 
tempted to explain the intermittent character of fever, by the fact 
that its cause is applied in an intermittent manner, and also that the 
functions of the organs in health are intermittent, t This certainly 
goes very far to account for the facts; but it does not seem to us to 
explain the existence of moderate continued fever, and malignant re- 
mittent or intermittent. If malignant intermittent result from the pe- 
riodical application of a violent cause, what must be the character of 
the cause which produces a mild remittent, or a moderate continued 
fever ^ On this subject we have yet much to learn. 

The organs which suffer under the influence of the gaseous poison, 

* MacciiUoch on Malaria, p. 275. 

I Goupil: Exposition des principes de laNouvelle Doctrine Mddicale, p. 177. 



Faust on Malaria. 5o 

vary according to circumstances, which are sometimes appreciable, 
but often very obscure. The mucous membrane of the stomach and 
small intestines is always inflamed; and in various cases, the large 
intestines, the liver, brain, and lungs, come into the catalogue of the 
semiologist, and we have dysenteric, bilious, ataxic, adynamic, and 
pulmonary complications.* None of these phenomena are contrary to 
what might be expected from carburetted hydrogen, after a full exa- 
mination of its effects. 

Patients who recover from the immediate violent eft'ects of the agent 
in question, but remain exposed to its influence, and suffer repeated 
attacks, finally die of chronic diseases. t The surface, constantly op- 
pressed by the debilitating action of the gas, sinks in the scale of vi- 
tality; it becomes pale, with a sallow, unhealthy tinge; its fulness 
and elasticity are lessened::]: its secretory power is weakened; and 
thus the system loses one of its most important depurating organs, 
the function of which must be supplied by an increased action in the 
others, and this increased action conduces powerfully to the produc- 
tion of visceral disease.§ The acute irritations of the abdominal vis- 
cera do not subside completely in malarial districts, nor in cases 
treated by emetics and other irritants. || When the use of tonics is 
practised with a view to accelerate convalescence, and strengthen 
the stomach, the same result occurs. In all these cases, the viscera 
lose the habit of healthy action; their secretions are vitiated, and be- 
come sources of disease; their vessels, always full and heated, ex- 
hale fibrin and albumen; thickening their membranes, and interrupt- 
ing the harmony of their actions. ^ The liver tumefies, becomes sore, 
and secretes vitiated bile. The spleen enlarges; sometimes to such a 
size as to become a deformity and a burden. •* The stomach excites a 
thousand unnatural and various symptoms, and disordered digestion 
constantly torments the individual. To these are added fits of cho- 
lera, dysentery, and other consequences of malaria or medicines. ft 
The sufferings of these organs are not confined to themselves, but ex- 
tend to the brain, the functions of which are profoundly modified, es- 
pecially when the uterus has suffered. ft The unnatural condition of 

* System der Practischen Hellkunde, von D. C. W. Hufeland; ZweyterBand, 
p. 5 and 6, Jena, 1818. 

f Macculloch, p. 6. i: Idem, p. 430. 

§ Translation of Broussals's Physiology, first Amer. edit. p. 407. 

U Broussais's Physiology, p. 327, 328, 329. t Idem. 

** Good's Study of Medicine, 1825, vol. 1, p. 279. f f Macculloch, p. 440. 

\\ De rirritation et de la Folic, par F. J. V. Broussais, 1828, p. 336, 337, 
338. 



56 Faust 071 Malaria. 

this organ excites in distant nerves unusual and painful sensations, 
which are constantly changing their seat,* and, of course, resist lo- 
cal remedies, while the internal medicines generally used, only per- 
vert, more profoundly, the sensibility of the abdominal organs and 
encephalon, and perpetuate the evils, which, for a moment, they had 
seemed to relieve. The brain thus responding to the sufferings of 
the digestive surface and other tissues, finally extends the excite- 
ment of its nervous matter to the capillary vessels, and mechanical 
lesions occur, which sometimes 'result in irremediable mania or idiot- 
ism, t In other cases, the changes occurring in the brain and spinal 
marrow, induce paralysis,t or convulsive affections; and as the foun- 
dation of these complaints is in the digestive surface, the prevalent 
treatment of cerebral diseases but too often increases the evil, by ir- 
ritating the stomach already too susceptible of stimulation, and too 
ready to react upon the nervous system. This reflection of the gas- 
tric impressions to the brain, and thence to all the nervous cords, es- 
tablishes in the latter points of irritation assuming the form of neu- 
ralgia. Hence, as Dr. MaccuUoch has explained, we find neuralgia 
in malarial districts, associated with or supplying the place of inter- 
mittent fever. Whenever this neuralgia is distinctly intermittent, it 
is very probable that there is a lurking irritation of the stomach; yet 
there is no evidence that neuralgia from causes entirely local, may 
not assume an intermittent character. When patients constantly ex- 
posed to the action of malaria, are able to support for some time the 
evil influence of this agent, they finally present the most striking 
pictures of general derangement of constitution. § The intellect is 
weakened; they become hypochondriac, neuropathic, the disposition 
is soured, the patient is ever complaining, and finally falls a sacrifice 
to some acute inflammation, or is carried off bj^ dropsy or some of the 
chronic visceral inflammations known by the English as marasmus. 
Will any pathologist imagine that these important effects are depend- 
ant upon any of the agents to which they are usually attributed? 
Such causes are not sufficient to explain the effects; but a sufiicient 
cause will be found in the substance, the properties of which have 
been explained in the preceding pages. We have every reason to 
believe, that the long-continued impression of this gas, so remarka- 
bly deleterious in its effects, will develope the whole train of symp- 
toms which we have but briefly stated. We have already called the 

* De Plrntation et de la Folic, par F. J. V. Broussais, 1828, p. 315. 

t Idem, p. 320, or MaccuUoch, p. 434, 435. 

i MaccuUoch, p. 440. ^ MaccuUoch, Chapter XL 



Faust on Malaria, 57 

attention of the reader to the resemblance between the symptoms 
produced by carburetted hydrogen, and those met with in the vari- 
ous idiopathic fevers of the ontologists; and this similarity should be 
considered as an argument in favour of the views which we have de- 
fended. 

Should our opinions prove correct, they ought to exercise a decided 
influence on all attempts to prevent the production and diffusion of 
malaria, and on the preventive discipline to which the individual is 
to be subjected. There is no doubt that many useful facts on the 
subject of prevention might have been determined, had more definite 
ideas prevailed on the chemical nature and physiological action of 
malaria, and it is not extravagant to hope that we may obtain at some 
future period comparative security from the effects of an agent which 
is not now resisted until its poisonous effects have been felt. 

After having discussed the comparative merits of the doctrines of 
malaria, so far as concerns its nature, and briefly noticed its influ- 
ence on the animal economy, we propose to make some remarks on 
the means most likely to prove useful in preventing its morbid in- 
fluence, and to consider the general principles of the treatment of 
fever, as suggested by its pathology.* The latter subject is at pre- 
sent so much discussed, and will be brought before the American 
public in so full and able a manner, that our observations need not 
be extended. 

The influence of drainage, and of the preservation of groves be- 
tween habitaiions and the sources of malaria, is very generally ap- 
preciated. The utility of smoke and fires was understood by Lancisi, 
and their value was practically illustrated by Napoleon. We quote 
from Dr. Macculloch, a very striking illustration of the principle: — • 

"One very pointed case, of a civil nature, is also worth recording-, because, 
while it is always particularly easy to imitate, and has been most unfortunately 
neg-lected, the circumstances are such as to interest ourselves, as colonists, under 
some of our least satisfactory experiments of this nature. In tliis case, the superin- 
tendent engag-ed in directing- the cutting of wood in Africa, erected thirty earthen 
furnaces on the spot where his men were employed, lighting them every day. 

* On this subject we cannot refrain from translating the sentiments of an 
eminent physician. "In this crisis it seemed to me to be salutary, nay, neces- 
sary, to select and fix a certain point, (standpunkt,) in which these various opi- 
nions might admit of being united, and employed for practical use, in which 
the good of all parties might be extracted, with the omission of the useless; 
the genuine practical results of all times might be received, and the medium 
kept between fruitless speculation and blind empiricism." — System der Prac- 
iischen Heilkunde, von D. C. TV. Hufeland. Erster Band, p. viii. Jena, 1818. 

6* 



5S Faust on Malaria. 

Before this he had always from forty to forty-eight of his workmen sick; when, 
in a short time, they were reduced to twelve, then to four, and finally to one."* 

The same practice modified, of course, according to circumstances, 
should be used in all cases in which it is practicable. On the same 
principles may we employ other vapours, such as those of vinegar 
and other acids, volatile oils, camphor, and in fact any volatile sub- 
stances capable of producing a decided stimulant impression without 
irritating too vividly the mucous membrane of the lungs. Such va- 
pours disengaged in houses may have some effect, though it will be 
limited, and caution will be required to prevent pulmonary disease. 
These means should be employed less with a view to decompose the 
malaria, than to preoccupy the cutaneous and pulmonary surfaces, 
b}^ an impression different from that of the gaseous agent, and thus 
prevent the production of that condition of the capillaries on which 
the excitement of fever in a great measure depends. We avail our- 
selves of a similar principle, in applying bark to the gastric surface, 
in the treatment of intermittent fever. It would be an interesting 
research, to ascertain the part played by the Schneiderian membrane 
in the development of malarial fever. The subject has not yet been 
examined, but it is possible that the impression made on the olfactory 
nerves may contribute much to the formation of gastritis. Everyone 
is familiar with the strong and instantaneous irritation developed in 
the stomach by certain odours; may not the inhalation of malaria, and 
its consequent action on the nerves, produce more slowly the same 
effect.^ It is true that the sense of smell is not affected by malaria, 
but this is not necessary, for it must be observed that some of the 
odours which produce the greatest gastric irritation, are extremely 
faint. The impression made on the nervous extremities, must pass 
to the brain and be reflected thence before it can reach the stomach,t 
yet it is not necessary that the mind shall be conscious of the impres- 
sion which first reaches the brain, and in many cases it perceives 
only the irritation v/hich the stomach directs to it. Thus, when to- 
bacco is applied to the surface, an irritation reaches the brain with- 
out exciting sensation, nor does this occur until the stomach, having 
received the impression from the brain, returns it in a sensible form. 
We make these suggestions to show that the subject deserves inves- 
tigation, for if fever be really communicable in this way, we may 
take advantage of odorous substances to anticipate the impression. 

Another means of modifying the state of the skin, so as to prevent 

* MaccuUoch on Malaria, p. 286. 

f Broussais; de I'lrritation et de la Folic, p. 296. 



Faust on Malaria. 59 

the influence of malaria, will consist in the application of various 
solids and liquids. Every medical man is familiar with the remarka- 
ble influence of oil in procuring immunity from the plague. 

" Mr. Tully has informed me, (says Dr. Good,) that there was no instance of 
. an attendant on the infected having- received the contagion so long as he was 
regular in thoroughly illlning himself with oil, wearing a dress soaked in oil, 
or a covering of oil skins."* " To the same effect it has been asserted by Mr, 
Baldwin of Cairo, that among upwards of a million of inhabitants carried off by 
the plague in Upper and Lower Egypt, during the space of four years, not a 
single dealer in oil, so far as he could learn, had fallen a sacrifice to it. A si- 
milar remark is made by Mr. Jackson, respecting the crolies or labourers in oil- 
warehouses, during the Barbary plague just referred to. In that of London, in 
1665, it is especially observed by Baynard, and most of the writers, that the 
trades chiefly exempted were those of oil-men, fishmongers, tanners, barge- 
men, and watermen, the first three evidently protected by the greasy viscidity 
that covered the hands and dress generally, and the last two by living separate 
from the scene of contamination, as though cut off by a quarantine. "f 

These facts are very remarkable; and it is a matter of surprise 
that they have been so much neglected. Should experiment demon- 
strate that malarial fever may be prevented in the same way, the es- 
tablishment of the fact would be invaluable to persons passing through 
districts abounding in malaria, or residing, for limited spaces of time, 
in situations almost certainly fatal. Moderate stimulants and slight 
astringents, combined with oily substances, might be easily applied^ 
and are worthy of a trial. 

Having suggested some prophylactic principles, we go on to make 
some brief observations on the treatment of the fevers produced by 
malaria. These observations are founded on the pathology of the 
diseases, as revealed by post mortem examinations, and on 'the re- 
sults of the various plans of practice most in vogue. 

All the sjmiptoms in the cold stage of malarial fever, demonstrate 
the existence of congestion of the encephalic, pectoral, and abdomi- 
nal viscera, with high irritation, especially in the abdomen. J Here, 
the common practice of administering active stimulants, especially 
laudanum and ammonia, is highly improper. These substances, if 
administered before the accession of chill, sometimes produce a dif- 
fused excitement, with warmth of the skin and perspiration, and this 
revulsion may interrupt the chain of morbid actions, and prevent the 
fit. If, however, this revulsion fail to take place, as often happens, 
or if the stimulants be given after the formation of the cold stage, the 



* Good's Study of Medicine, 1825, Vol. II. p. 439. f Idem, p. 440. 

+ Broussais; Histoire des Phlegmasies chroniques, 1826, Vol. III. p. 335. 



60 Faust on Malaria. 

irritation of the digestive organs is aggravated, the hot fit is render- 
ed more severe, and the next fit is apt to be more intense. Instead, 
then, of this uncertain and dangerous treatment, administer inter- 
nally very gentle diffusible stimulants, such as warm decoctions of 
orange leaves or sage. To aid these in determining to the surface 
and destroying the internal congestion, apply warmth extensively to 
the skin, and use friction, if this can be done without admitting cold 
air. These agents will lessen the intensity and duration of the con- 
gestion, without sensibly increasing the hot stage. In malignant cases 
in which the congestion is very great, and there is danger of death 
before the formation of the hot stage, it has been recommended to 
employ free bleeding from the arm, and cases are detailed, in which 
this practice interrupted the congestion immediately and saved the 
lives of the patients.* We cannot speak from experience on this 
subject, as we have used the lancet but once in the cold stage, and in 
that case, which was mild, there was no decided effect. Yet, should 
we ever employ it in malignant cases, it will be with fear and trem- 
bling, and with extreme hesitation; for though general bleeding may 
destroy the congestion, yet it may fail, and in the latter case, the vi- 
tality, already alarmingly depressed, may be utterly extinguished. 
What would be the feelings of the physician, in such a case.^ The 
use of tourniquets, and some other means, need not be discussed 
here. 

After the cold stage has passed by, our object is to lessen the vio- 
lence of the hot fit. As the foundation of a rational practice, we must 
learn from pathological anatomy, the nature of the disease. This 
teaches us, that it consists in inflammation of the digestive surface. 
To this rule, exceptions, if they ever exist, are extremely rare. Ir- 
ritations of the brain, liver, lungs, and other organs, may or may not 
exist, at the same time, as effects of external circumstances, or of the 
gastro-enteritis. If we be told that these lesions are accidental, we 
appeal to the pathological anatomist for irresistible proof. If it be ob- 
jected, by those to whom a disease is a set of symptoms, that these 
plienomena are mere effects of the disease, we reply, that those sub- 
stances which inflame the stomach, produce all the characteristic 
symptoms of these diseases; we reply, also, with Roche, the ingeni- 
ous pupil of Broussais, by asking the ontologists whether heat of the 
skin, rapidity of the pulse, pains of the limbs, head-ache, thirst, 
nausea, scanty secretion, &c. redden the mucous membrane, in- 
ject its blood-vessels, and produce softening, ulceration, or even 

* Amer. Journ. of Med. Sciences, Nov. 1827, p. 227. 



Faust on Malaria. 61 

perforation?* if not, we cannot agree that this entity, existing in their 
own minds only, produces all or any of the mischief with which it is 
so unfairly charged. 

Emetics were formerly much in vogue, and are still used by many 
practitioners. The effect of emetics is, to exalt the vital actions of the 
digestive membrane and its glandular appendages; and this irritation 
is evinced by the nausea, the excessive contraction of the muscular 
fibres of the stomach, and the increased secretion of bile and pancre- 
atic fluid. This last circumstance is the source of a great error in 
those persons, who, having a bilious taste in the mouth, take an eme- 
tic, and vomit large quantities of bile and mucus, the removal of 
which is set down to the credit of the emetic, while, in reality, it had 
not been in the stomach before the medicine was taken. Emetics may 
cure gastric irritation in three ways: first, by exciting free secretions 
from the diseased surface, thus establishing an artificial crisis; se- 
cond, by irritating a portion of mucous surface not yet diseased, and 
thus procuring relief on the same principle of revulsion as in the ap- 
plication of a blister; third, by transferring the irritation to the skin, 
as is very common, thus inducing critical diaphoresis, or to any other 
organ, especially of the nervous system, which may chance to be irri- 
table. All these chances, for they can be viewed in no other light, 
often fail; and when this happens, evil results are almost certain; be- 
cause the degree of revulsion, will, of course, very rarely balance the 
irritation of the emetic, so that it shall do neither harm nor good.t 
A late writer, after defending emetics as one of the best prescriptions 
in fever, observes, that no intelligent practitioner has fiiiled to see, 
in the course of his practice, some cases, in which a single emetic 
has placed the patient beyond the hope of recovery; and the misfor- 
tune, he observes, in these cases is, that this fatal result cannot be 
foreseen. It ought, then, to be a matter of conscience with the prac- 
titioner, whether or not he will administer a medicine which some- 
times proves fatal, while there is no means of foreseeing, in any case, ' 
the result. I know not how he will avoid this objection. In slight or 
moderate fevers, the revulsion often cures; but in proportion as the 
gastro-enteritis is more acute, so does the probability of secretion or 
revulsion to other tissues diminish. All this coincides with the laws 
of the system, by which membranes cease secreting, when excited to 
a certain point,:}: and by which all revulsives fail oftener in acute ir-= 

* Broussais; De rirritation et de la Folie, 1828, p. 414. 

t Broussais's Physiology; Chapter on Abnormal Assimilation. 

t Jackson, in Amer. Journ. of Med. Sciences, for Feb. 1828, p. 271, 



62 Faust on Malaria, 

ritations than in mild cases.* When the inflammation amounts to well- 
formed and active bilious fever, emetics rarely fail to do evident mis- 
chief; this we have repeatedly seen. The most dangerous of those 
commonly used is emetic tartar, the etFect of which is sometimes ac- 
tually poisonous, t We have seen cases in which it excited the most 
intense irritability of the stomach, nor are we at a loss for others in 
which it produced speedy death, t. The combination of tartar with 
Epsom or Glauber's salt, is still more to be dreaded; its effect is ar- 
tificial cholera. § In short, the effect of emetics is so uncertain and so 
often unfortunate, especially in serious cases, that they should not be 
used in fever, unless for some urgent complication, in which warm 
water should be employed. 

In England, and in this country, there is an immense consump- 
tion of cathartics; not in fever only, but in all other diseases. 
We know no exception to this statement. Physicians have been 
so prodigal in this respect, that every man who feels unwell, re- 
sorts, as if by instinct to catharsis; and as we do not generally 
see patients in the very commencement of their diseases, so do 
we usually see them after they have been freely purged, if not vomit- 
ed. Dr. Dickson, of Charleston, a man whose brilliant and sound 
intellect, will place him on a high pinnacle of medical fame, ob- 
serves, when treating of the use of calomel in yellow fever, that in 
serious cases he employs '' not less than 9j. at a dose, to be repeat- 
ed every two, three, or four hours, and very often gives Jss. at the 
same intervals. My object," lie says, '« is to exhibit the maximum 
quantity of the medicine — the largest amount capable of acting re- 
medially. On this principle I would not hesitate to administer an 
ounce at the dose if I thought that the stomach would bear it, and 
the system receive more readily its peculiar influences. "|j Let us 
analyse the action of mercurials and cathartics. They sometimes 
produce vomiting; they therefore irritate. They increase intestinal 
contraction; another proof that they irritate. They increase the se- 
cretions of the liver and mucous membrane; the constant effect of ir- 
ritants. When given in excessive doses they acutely inflame the mu- 
cous membrane. •[[ From these properties it may be determined whe- 
ther they may be used with safety in gastro-enteritis. Many of the 
greatest authorities of both ancient and modern times have proved 

* Benin's Therapeutics, Vol. II. p. 100, 1829. 

-j- Heustis, in Amer. Journ. of Med. Sciences, for May, 1828, p. 40. 

t Idem; also Orfila. § Heustis in the same, p. 41. 

ij Amer. Journ. of Med. Sciences, for May, 1828, p. 75. 

^ Murray's Materia Medica, 1824, p. 185. 



Faust on Malaria. 63 

that they cannot. Cathartics may cure gastro-enteritis by exciting 
Jree secretion from the inflamed surface; but cure is by no means a 
constant effect of this.* They may cure inflammation of the upper 
part of the canal by the revulsive irritations which they excite in the 
lower portions of the same, and vice versa. In the latter way do 
emetics sometimes cure dysentery. Both of these effects very often 
fail, and their chance of success diminishes with the severity of the 
disease, for when the inflammation reaches a certain point, the mem- 
brane refuses to secrete, and here the irritation produced in the lower 
intestine must amount almost to dysentery, before it can be a revul- 
sion from the stomach, liver and small intestines. Who will venture 
such treatment, when he reflects that if his remedy fail to relieve, it 
will be seriously injurious ? About three years since, we gave, in a 
case of acute gastro-enteritis, with much soreness of the epigastrium, 
a large dose of cream of tartar with jalap. The patient being an old 
lymphatic woman, and the inflammation confined almost entirely to 
the stomach and duodenum, a most fortunate revulsion took place, 
with large secretions, and in twenty-four hours the patient was well. 
This we explained on the ground of the removal of morbid matter 
from the blood, and some other hypothetical views which we are now 
forgetting. A few months since, the same patient experienced a simi- 
lar attack of rather less severity. As the disease was moderate, and 
the temperament by no means nervous or sanguine, we gave at first 
three drachms of sulphur, and as this did not operate, we adminis- 
tered, rather carelessly, after a few hours, one drachm of the carbo- 
nate of magnesia. The consequence was six free operations, with ra- 
pid and dangerous congestion of the liver, which finally yielded to 
local bleeding, fomentations, mucilaginous drinks, and enemata. 
This case, which is but the type of thousands, shows us what faith 
we are to put in catharsis, as a means of cure in fever. We recollect 
the case of a young person of an irritable temperament, complaining 
of loss of appetite, bitter taste in the mouth, and head-ache, to whom 
we gave ten grains of calomel. In three hours it excited acute gastro- 
enteritis, which very nearly proved fatal; and a similar treatment be- 
ing continued, the constitution received a shock, which, from present 
appearances, will, I am persuaded, never be entirely recovered. We 
readily make these confessions for the benefit of others, because, 
when a few years since, we made these errors, our reading had been 
confined to the then empirical works of our own language, and we 
had not corrected our errors by observation. Under our present 

* Jackson, in Amer. Journ. of Med. Sciences, for Feb. 1828, p. 272. 



64 Faust on Malaria. 

impressions, a similar practice would be culpable, and we shall 
never follow it. Our friend from whom we have already quoted 
on the mercurial treatment of fever, says, '' I saw no patient die sa- 
livated. I saw no case which was not surely and at once alleviated, 
as soon as ptyalism was brought on."* This is a very singular fact; 
for although Dr. Dickson's opportunities for observation have been 
far more extensive than our own, yet we know several cases of death 
from fever in Columbia, although free salivation was procured in all, 
and we have positive evidence of similar facts from several of our 
medical friends. There can be no error on the part of Dr. Dickson, 
for he is not a superficial observer, and chance is the only explana- 
tion we can give. We would add, that the negative evidence of this 
author, cannot, on philosophical principles, be opposed to our own 
positive facts. No physician who has not made the experiment, can 
form a just idea of the very small quantity of cathartic medicine re- 
quired in the treatment of fever; and the only way to become fully 
sensible of the unnecessary and disadvantageous irritation v/hich they 
excite is to observe the progress of cases treated without them. My 
observation of the comparative duration of summer and autumnal remit- 
tent fever, under the system of free purging, sudorifics, &c. and un- 
der that to which I shall soon proceed, will give about two and a half 
or three weeks for the former, and one for the latter; yet it will re- 
quire further observation to determine this point exactly. 

As we would not advocate the entire exclusion of laxatives from 
the treatment of fever, we shall state hereafter some cases in which 
we have used them with ex.cellent effect. 

Among the irritants used in the treatment of fever, sudorifics and sub- 
stances supposed to be so, hold a conspicuous place. Emetic tartar in 
small doses, pulvisantimonialis, nitrate of potash, ipecacuanha, Dover's 
powder, and acetate of ammonia, are the most common. These me- 
dicines are of less value in gastro-enteritis, than those already men- 
tioned. They may cure, or at least relieve gastro-enteritis, by excit- 
ing secretion and catharsis, as sometimes happens in the action of 
emetic tartar, pulvis antimonialis, and ipecacuanha; by transferring 
the irritation to a portion of membrane not inflamed; finally, by trans- 
ferring it to the skin, and exciting perspiration. The objections urged 
against emetics and cathartics are applicable to these. When they 
act well they often fail to produce much impression upon the disease, 
and when they do not succeed in revulsion or secretion, they irritate 
a surface already inflamed, and generally increase the inflammation, 

* Amer. Journ. of Med. Sciences, for May, 1828, p. 74. 



Faust on Malaria. 65 

drying and parching the tongue and skin, and producing nausea and 
head-ache. Nitre especially, is at once useless and injurious, and its 
use is common in proportion to its want of value. We have never 
been able to obtain any proof of its diaphoretic action, and we have 
no doubt that physicians have used it altogether on the authority of 
others, who themselves have taken their opinions from tradition. We 
have never known it to produce diaphoresis, or any other good effect 
in fever. It is much used as a refrigerant; those using the term hav- 
ing very indefinite ideas of its m.eaning in this instance. Its only 
advantage is, that it cools the water in which it is dissolved; but this 
is far more than counterbalanced by the impression which it exerts 
upon the inflamed membrane. Its well known effect, when given in 
large doses, is the production of intense gastro-enteritis, with bloody 
discharges.* It should be banished from the treatment of fever. Mild 
diaphoretics, given when a paroxysm is subsiding, sometimes induce 
perspiration with excellent effect; yet this result is by no means con- 
stant, and sometimes a contrary result is produced; so that this class 
of remedies is not applicable to many cases. The best mode of pro- 
curing perspiration is to remove that inflammation of the mucous 
membrane to which the dryness and heat of the skin are attributable; 
the skin will then often secrete spontaneously. When the mucous 
membrane is thus relieved, we will generally succeed in restoring 
perspiration by very mild diaphoretics, with little or no danger of 
producing any irritation; or if this arise it is trifling and easily re- 
moved. But so long as there is a gastric irritation of any importance, 
i. e, so long as there is decided fever, mild diaphoretics will usually 
fail, from want of activity, and those of a more active nature will also 
fail by irritating the stomach. 

Our limits, and the nature of the present paper, will not allow us 
to consider more particularly the employment of irritants, but the in- 
telligent reader will be able to extend for himself the principles al- 
ready stated. We proceed to the proper treatment. 

If the disease commence vrith very intense excitement of the cir- 
culatory organs, evinced by a rapid, full, and hard pulse, especially 
if the epigastrium be painful and swollen, or if there be intense head- 
ache, with injection of the face and eyes, the patient should be seat- 
ed upright, and bled in a full stream from the arm, until the pulse 
becomes less violent. The capacity of the patient to bear this, must, 
however, always be kept in view. When there is active congestion 
of some important organ, the pulse, though often small, will fre- 

* Paris's Pharmacologia, 1825, p. 452. 
No. XL—May, 1830. 7 



66 Faust on Malaria. 

quently be corded, tense, and hard. Here the lancet is generally de- 
manded, and may be used with tolerable freedom, especially if the 
pulse soften and dilate during the flow of blood. We have often been 
surprised at the unpardonable negligence of authors, in not giving 
proper cautions concerning the employment of the lancet in persons 
addicted to the use of alcoholic liquors. They bear the lancet less 
than any other class of patientsj and it would, perhaps, be a good 
rule, to forbid it entirely in these cases; for though some patients will 
demand it, yet these are very rare, and still more rare are physicians 
who can recognise them. In fact, the question will often be beyond 
the reach of human sagacity. In an immense majority of fevers, the 
lancet is not proper; yet those cases in which it is safe and useful, are 
certainly more numerous in scattered and vigorous populations, than 
we would be led to expect, from the opinions of authors who have 
practised among the weakened constitutions of large and luxurious 
cities. We may content ourselves with these few observations on ge- 
neral bleeding, as it would require a volume to do justice to the sub- 
ject, and such a volume is very much needed in our language.* 

The writings of Dr. Currie,t and the useful analysis of his work 
published by Dr. Thacher, in his Dispensatory, have sufficienly fa- 
miliarized the medical world with the great value of cold water, ex- 
ternally applied, in most cases of fever. Where it is not unpleasant 
to the patient, and where the heat is very intense, it may be used in 
the form of cold affusion; in other cases sponging may be employed; 
in either way the effect is excellent. If the skin be very moist dur- 
ing the fever, or if there be great debility from diarrhoea, this appli- 
cation is not safe. J As a general rule, it is not adapted to exanthe- 
matous fevers; but rosalia constitutes an exception. § In cases in 
which for some hours after the commencement of a paroxysm, there 
is alternation of heat and chill, it should be avoided until the hot fit 
is fully established, though it may sometimes be used earlier with 
good effect as we have experienced. 

The next step, and the most efficacious of all, is depletion from 
the epigastrium. The quantity of blood drawn must be regulated by 
the strength of the patient, and the character, intensity, and stage of 
the disease. It will be extremely rare for this depletion to fail in 



* A translation of Poliniere's Emissions Sanguines Artificielles, would be 
valuable. 

f Medical Reports on the Effects of Water, Cold and Warm, &c. 

+ First Amer. edition of Gregory's Theory and Practice, 1826, Vol. I, p. 72>. 

§ Idem, p. 231. 



Faust on Malaria. 67 

producing a rapid and distinct alleviation of the disease. If the 
symptoms should rise again after the first local bleeding, the remedy 
is to be repeated according to circumstances. Certain states of pros- 
tration in typhus,* and of acute gastro-enteritis supervening upon a 
chronic form of the same disease,! counterindicate local bleeding; 
but the extent and importance of this subject obliges us to refer to 
other authorities. If there arise, in the course of the disease, symp- 
toms of meningeal or cerebral irritation, as intense head-ache, deli- 
rium, tendency to stupor, subsultus tendinum, or extensive soreness 
of the skin, and the depletion from the epigastrium do not soon alle- 
viate this condition, it will be proper to apply leeches along the caro- 
tids, to the temples, behind the ears, or to any part of the head which 
may be very painful. J Here, also, the application of cold to the head 
will be proper, if it be hot and not covered with perspiration. On the 
same principles we shall apply leeches to the region of the liver, if 
that organ be congested or inflamed, around the umbilicus if great 
thirst and soreness of that region indicate predominance of irritation 
in that part,§ and to the perinseum, hypogastrium, or course of the 
colon, if diarrhoea, dysentery, or other symptoms of irritation in the 
large intestines exist. If the fever be complicated with inflammation 
of the respiratory organs, leeches and emollients should be applied 
to the chest, and the drinks should not be so cold as in uncomplicat- 
ed gastro-enteritis. The reader will find, in the writings of Brous- 
sAis, Begin, Boisseau, and Goupil, those details on this subject, 
the possession of which is essential to every practitioner. 

The application of emollient fomentations to the abdomen will be 
useful, as they have a considerable influence in calming the internal 
irritation, provided they be constantly used. If the abdomen be very 
hot, the fomentations may be cold, in fact ice water is sometimes ap- 
plied to the epigastrium with great advantage. If the heat be mode- 
rate, they may be temperate or even tepid Their effect is always 
good, and often surprising* 

During the course of the fever, the drinks should consist of cold wa- 
ter, pure, or acidulated with lime juice or tartaric acid, to which may 
be added white sugar. Mucilages, also, will be very useful, and they 
■may be acidulated and sweetened as the water. They should be made 
from those substances of which but little is required to render the 



* Goupil; Exposition des Principes de la Nouvelle Doctrine Medicale, 1824, 
p. 503. 
t Idem. t Begin's Therapeutics, Vol. I. p. 191. 

§ Translation of Martinet's Manual of Patholog-y, 1827, p. 118, 216. 



68 Faust on Malaria. 

drinks mucilaginous. Tragacanth is the best of the gums, and bene 
the most convenient and agreeable of the vegetables. All vegetable 
infusions of an aromatic or otherwise irritant nature, as well as so- 
lutions of animal matter, must be carefully avoided, aS our object is 
to present to the digestive surface bland and debilitating fluids only. 

Especial care must be taken throughout the disease, to avoid con- 
stipation, and this must be done with as little irritation as possible 
to the inflamed surface. Local depletion and fomentations will fre- 
quently effect this object, but it will often become necessary to em- 
ploy enemata. These, at first, should be simple and unirritating, 
but when mild fluids fail to produce a proper effect, moderate quan- 
tities of cathartic substances may be added. It must be recollected 
that enemata cannot be employed when there is much irritation of 
the rectum. In almost all cases, the treatment above advised will 
keep the bowels sufficiently open, but in some cases enemata will fail 
to produce evacuations, and the costiveness will produce evident bad 
effect. Here, then, laxatives, if judiciously used, may be highly be- 
neficial. If the tongue be red, pointed, and dry, or covered with a 
dark and cracked coat, and the skin dry and parched, with tension 
and pain of the abdomen, or other symptoms of very acute inflamma- 
tion, these symptoms must be reduced by local bleeding, &c. before 
we can venture upon laxatives, which under these circumstances are 
very hazardous. When, however, the abdomen is soft, the heat mo- 
derate, and the tongue broad, moist, and merely furred, without 
much redness, the mildest laxatives, such as castor oil, magnesia, 
cooked prunes, and tamarinds, given in small quantities at moderate 
intervals will be eminently serviceable, especially if assisted by ene- 
mata. In no case is free purging proper. 

If, during the progress of fever, the gastro-enteritis become com- 
plicated with cerebral irritation and congestion, not yielding to local 
depletion, we must resort to revulsives. If the patient be perfectly 
sensible, the irritation increasing rather than diminishing the gene- 
ral irritability, we must carefully avoid those revulsives which excite 
pain, as they are apt to increase the determination to the brain, and 
rekindle any febrile symptom which may have diminished. In these 
cases wrap the legs and thighs in blankets wrung out of hot water, 
and renew them as soon as they begin to cool. The legs may also be 
kept in hot water containing a sufficient quantity of mustard to sti- 
mulate moderately without causing pain. The application must be 
continued for many hours. When the brain becomes so much con- 
gested as to produce a diminution of sensibility, or even coma, pain 
is less easily excited, and stronger irritants may be employed. Sina- 



Faust on Malaria. 69 

pisms, ammonia, and the solution of cantharides in turpentine may 
be used, if the sensibility be sufficiently diminished. They may be 
applied to more or less extensive surfaces of the legs and thighs, and 
to the back of the neck. The greatest danger is in irritating the brain 
by pain. 

The hot stage of intermittent fever is to be treated as already di- 
rected. Sulphate of quinine and other febrifuges are to be used in 
the intermission, and our great object is to render this as perfect as 
possible. In common intermittents, the tonic must not be used until 
all the febrile symptoms are dispersed, and the skin is cool, the pulse 
natural, and the tongue nearly clean and not too red. Before this, 
tonics are very apt to aggravate the paroxysms. The diet during the 
apyrexia must consist of vegetable solutions, as of barley, sago, and 
arrow root. It will rarely be safe to use tonics in the first interval 
of common intermittent, or at any period of moderate remittent. 
When, however, the disease is very malignant, and there is danger 
of death in the next paroxysm, we cannot depend on antiphlogistics 
alone, but must resort to the sulphate of quinine in the remission. If 
the stomach reject it, throw it into the rectum, and rub the skin with 
the tincture of bark. If there have been several paroxysms, and the 
pulse be small, feeble, intermittent, the skin livid or pale, and the 
patient senseless, avoid even local bleeding, apply to the legs and 
thighs the most rapid rubefacients, while a solution of several grains 
of sulphate of quinine is thrown into the rectum, and the skin is rub- 
bed with the tincture of bark. The tonics are dangerous in these 
cases, but without them the danger is greater. 

During convalescence from fever, all stimulants must be shunned 
as tending to renew the gastro-enteritis. The diet should consist, at 
first of the vegetable solutions above mentioned, and the return to 
common food should be very gradual. 

Our limits have allowed us to state the fundamental principles only 
of the treatment of malarial fever, and the authors of the physiologi- 
cal school must be consulted for more minute details. 

From the present state of our knowledge of malaria, we think that 
the following conclusions may be drawn: — 

That malaria has exerted its influence on man and domestic ani- 
mals* in all ages. 

That it possesses properties different from those of volatile solids 
and liquids, as well as from those of animalculae and uncombined 



* For its effects on domestic animals, see Chapter XI. of Macculloch. 

7* 



70 Byrne's Case of Recto-Vaginal Fistula. 

That as it has not been obtained in an insulated state, and as its 
properties coincide exactly with those of that combination of water 
and carburetted hydrogen which arises from marshes, we may fairly 
conclude that they are identical. 

That it acts primarily on the cutaneous and pulmonary surfaces, 
and that its effects may be prevented. 

That the internal inflammations created by carburetted hydrogen 
should be treated by antiphlogistics, and not by irritants. 

Columbia, S. C, January, 1830. 



Art. IV. Case of Fistulous Communication between the Vagina, 
Bladder, and Rectum. By Charles Byrne, M. D., U. S. Ar- 
senal, near Baltimore. 

On the 18th of November, 1826, I was called to visit Mrs. M'K. in 
labour with her first child. The waters, I was informed, had been 
discharged before my arrival. On examination, I found the pelvis 
well formed. The os uteri had dilated to about the size of half a 
dollar, the vertex presenting. The woman had enjoyed good health 
during gestation, the pains were strong, and every symptom seemed 
to indicate a safe and speedy delivery. The head, however, advanc- 
ed very slowly, and at the expiration of twenty hours had not en- 
tirely cleared the superior strait. At the end of ten hours more it 
was found presenting at the labia externa; but the pains had entirely 
subsided, and the patient seemed very much exhausted. The case 
now, for the first time, in my judgment, demanded the interference 
of art, and I accordingly proceeded to render assistance. By intro- 
ducing the forefinger of the right hand into the child's mouth, and the 
other hand behind the occiput, it was extracted with little diffi- 
culty. The child was dead, and bore all the marks of severe com- 
pression. The bones of the cranium were firmly united, and would 
not yield to the strongest pressure between the hands, to which cir- 
cumstance I must attribute the difficulty of the labour, and the me- 
lancholy effects which followed. 

After trying every means for the space of an hour to promote the 
expulsion of the placenta, without success, 1 introduced my hand into 
the uterus, and found that viscus in the state which has been called 
tlie "hour-glass contraction. " By following the cord, I found that the 
placenta was attached to the fundus uteri, and was of course confined 



Byrne's Case of Recto- Vaginal Fistula. 71 

in the superior division of the hour-glass. I had some difficulty and 
considerable delay in overcoming the contraction, but finally suc- 
ceeded. 

The patient seemed now quite composed, took some nourishment, 
passed her water naturally, and slept well through the night. But 
next morning it was observed that the fasces passed off involuntarily. 
The urine was still subject to the will. 

The second day the urine and faeces both came away involuntarily. 
These unpleasant effects I thought might arise from the temporary 
suspension of the powers of sphincters ani et vesicas, caused by the 
severe compression of the child's head during labour. In every other 
particular, the patient seemed to be doing very well. Her appetite 
and strength improved. On the four succeeding days, no command 
over the evacuations. Applied decoctions of various astringent ar- 
ticles over the pelvis without any benefit. 

Q8th. — The nurse reports that the fseces passed through the vagina 
this morning; and on particular inquiry I found that the urine came 
away in such quantity, and so suddenly, when the patient rises or 
changes her position, that I thought it impossible it could come through 
the urethra, and was therefore unavoidably led to the conclusion that 
an opening had been formed between the bladder and vagina, as well 
as between the latter and the rectum. This might be produced in 
both instances by the destruction of the vessels of the parts by the 
long and severe pressure of the child's head. The faeces passed 
through the natural channel for some time after delivery, which 
only proves that although the life of the parts was destroyed, the 
communication had not been fully ormed by the sloughing of the 
dead parts till some time after. On the second day after delivery, 
the urine passed oft' in the manner described, or, in the language of 
the nurse, ''all in one dash,^^ so that before she could set a vessel 
under her " it was all in the bed." 

Although from all this it was impossible to mistake the situa- 
tion of things, I resolved to satisfy my mind more fully by touching. 
But on introducing my fingers into the vagina, I found it filled with 
faecal matter, and the parts so inflamed and irritated by the constant 
passage of the evacuations that it was impossible to move them in 
any direction with a view to make an examination, without putting 
the patient to great agony^ I therefore desisted for the present. 

Ever since delivery the right leg and thigh are occasionally seized 
with tremors, which shake the whole bed, and are very distressing. 
She complains of cramps and great weakness in both limbs. 



72 Byrne's Case of Recfo- Vaginal Fistula. 

December 4th. — I introduced a catheter, and after drawing off the 
contents of the bladder, which was very turbid and of a faecal odour, 
I introduced the forefinger of my right hand into the vagina, just be- 
hind the pubis, and by directing the catheter with the other hand my 
finger came in contact with the naked instrument. The opening in the 
bladder seemed to be considerable. I then secured the catheter in the 
urethra, by means of tapes fastened round the pelvis, with a view to 
drav/ off the urine as it collected, and give an opportunity to the 
wounded bladder to heal. 

12th.' — Expressed herself very much relieved by means of the cathe- 
ter, and was not sensible that any portion of the urine passed through the 
morbid opening. Part of the fseces passes sometimes per anum, but 
still involuntarily. Her appetite and general health pretty good, but 
lower extremities very weak. 

I6th. — Had an ague and fever at night, and several others at irre- 
gular intervals every succeeding day and night. Appetite bad; great 
irritability of the stomach; complains of pains across the breast and 
abdomen. 

The symptoms of constitutional irritation, from the 16th, on which 
she had the first ague, till the 29th, the day of her death, continued 
to increase. She first complained of pains in the loins and across the 
abdomen; the stomach became extremely irritable, rejecting every 
thing; the tongue, at first whitish, as the irritation advanced became 
yellow; the pulse weak and irregular; the cheek alternately flushed 
with a hectic glow and pale as death. 

Although under those circumstances I was well aware her dissolu- 
tion was feist approaching, it occurred sooner than I'had anticipated, 
in consequence of which, as she had resided at a considerable dis- 
tance, I lost the opportunity of making a post mortem examination, 
which I was very anxious to do, as I considered the case one of great 
interest. 

That her death was caused by the general irritation produced by 
sympathy with the diseased parts, there can be no doubt, and the 
only light dissection could throw on the subject would be to show 
how far the sphacelus had proceeded in the parts, and how far, if at 
all, nature had proceeded in her efforts at restoration. 

U. S. Arsenal, near Baltimore, Feb. 1830. 



Heustis on the Liver and Spleen. 



Art. V. Inquiry into the Functions and Pathology of the Liver and 
Spleen, and Remarks on the Influence and Effects of Mmospheric 
Temperature as connected with the Origin and Prevalence of 
Disease, ^c, Bj J. W. Heustis, M. D. Author of Physical Obser- 
vations and Medical Tracts and Researches on the Topography 
and Diseases of Louisiana; and of Medical Facts and Inquiries on 
the Endemic Fevers of Alabama. 

A FULL discussion of the subject of the present inquiry would occu- 
py volumes instead of pages, and much transcend the usual limits of pe- 
riodical publications. I shall, therefore, merely trace some of the 
most prominent features, leaving the more elaborate points of con- 
troversy and speculation to those whose talents, leisure, and incli- 
nation are more adequate to the undertaking. Perhaps, on another 
occasion I may make a few observations on the debatable questions 
of the origin, contagion, and nature of the yellow fever, but at pre- 
sent I shall confine myself to a few hasty sketches in relation to the 
subjects under the above titles. 

The importance attached to the function and influence of the liver, 
as connected with the phenomena of health and the symptoms of dis- 
eases, is a physiological and pathological fact too well established to 
admit of contradiction. But though the distinguished consequence 
of this important organ is thus generally acknowledged, there still 
exists considerable uncertainty and doubt with respect to its particu- 
lar ofiice and design in the animal economy. It is with the view of 
drawing together a few facts in relation to this and the other collate- 
ral subjects of the present inquiry, and making such physiological and 
pathological deductions, therefrom, as they may seem legitimately to 
warrant, that the writer of this essay now claims the attention and 
indulgence of the reader. 

Unlike every other gland in the body, it is a received opinion that 
the secretion of the liver takes place from venous blood, from blood 
highly charged with carbon, hydrogen, &c. in a state of the greatest 
possible impurity consistent with the well being of the system, and 
such as is totally unfit for any other secretion in the body. The pre- 
sumption is, that the blood returned by the vena portarum, particu- 
larly that by the mesenteric veins, brought back from the many con- 
volutions of the bowels, is more highly vitiated and surcharged with 
impurities than that from any other part or portion of the body. If, ac- 
cordingto some modern physiologists, the veins may also be considered 
to act as absorbents, we may suppose that the venous blood sent to 



74 Heustis on the Liver and Spleen. 

the liver abounds in matters too gross to be eliminated by the ex- 
halents of the lungs, and unfit for the secretory action of the skin and 
kidneys, and therefore requiring to undergo a previous straining and 
purification in the liver. 

For the purpose of preserving the body in a state of health, we find 
that nature has furnished it with various provisions, and which, un- 
der ordinary circumstances, are capable of fulfilling the wise and be- 
nevolent designs of the Author of our being. Against the friction, 
wear and tear^ deterioration, malaria, and various noxious agents to 
v/hich the animal frame is subject and exposed, we find the resources 
of the system wonderfully and admirably adapted. And though phy- 
sically consistent with the same Divine Power which called man into 
existence, to continue and perpetuate his being in the present state 
ad infinitum, yet for wise and superior purposes such is not the tenure 
of his life. Frequent disease and incidental infirmity admonish him 
of his frailty, and carry conviction that inanimate is at constant war 
with animate matter, and that the latter must ultimately yield to the 
dominion of the former. Yet the powers and resources of the system 
are so adjusted to its various necessities, that under favourable cir- 
cumstances they may long move on in uninterrupted harmony of ac- 
tion. For the support and preservation of the body, we find a provi- 
sion of various viscera and organs. Of these some are intended for 
the preparation of the food, others for the purification of the blood, 
the immediate pabulum of life, and others, again, for various neces- 
sary purposes and uses in the animal economy. 

The purifying organs of the body may be set down in the following 
order: 1, the cuticular^ 2, the urinary; 3, the pulmonic; and 4, the 
hepatic. These may again be divided into two sets, according to the 
aflinities and mutual relations subsisting between them. 1st. The 
cuticular and urinary, which, by way of brevity may be styled uro- 
cuticular. 2d. The pulmo7iary and hepatic, which for the same reason 
as the preceding, we would term ih.e puhno-hepatic. Between the or- 
gans composing each of these divisions, nature appears to have esta- 
blished an intimate relation. The vicarious relation of the function 
of the skin and the kidneys is too well known to require illustration. 
And the mutual aid and co-operation of these two great viscera, the 
lungs and the liver, in the purification of the blood, receives confirma- 
tion and support from various considerations. 

We will assume it then, as a physiological fact now generally ad- 
mitted, that the bile is secreted from the blood of the vena portarum. 
As this blood abounds with impurities which it has acquired in the 
course of the circulation, we necessarily conclude that the secretioB 



Hcustis on the Liver and Spleen. 75 

which takes place from it, must be to a considerable degree effete 
and excrementitious^ and that the grosser, carbonaceous, saline, bit- 
ter, fatty, and resinous portions combining with the excrementitious 
part of the food, pass off by the intestinal canal, whilst the albu- 
men and other portions necessary and useful in the formation of 
chyle unite with this fluid, and thus assist in the assimilation of the 
alimentary matter, and its gradual conversion and approximation to 
animal substance. The blood of the vena portarum, having under- 
gone filtration in the liver, is returned to the right side of the heart, 
from whence it is sent to the lungs, where it becomes still more de- 
carbonized, and undergoes the last stage of purification, when it is 
again fitted for the various purposes of the expenditure and nutrition 
of the animal economy. 

The resinous and bitter portion of the bile has been considered the 
natural stimulus and cathartic of the intestines; this is inferred from 
its sensible properties, and from the torpor and constipation of the 
bowels which exist in those cases of jaundice where the common bi- 
liary duct has become obstructed. Were the bile merely excre- 
mentitious, we could hardly suppose it would be poured into the duo- 
denum together with the secretion of the pancreas, to be mixed with 
the food that has undergone digestion, and not rather into the colon, 
or have been furnished with a more immediate outlet. If it be object- 
ed that such an arrangement would have deprived the bowels of their 
natural stimulus, it may be replied that had not nature intended the 
bile for other purposes than that of a gentle and permanent cathartic 
to the intestines, siich a cathartic would not have been required; or, 
in other words, the alimentary canal would have stood in no need of 
such a stimulus in order to promote and perpetuate its peristaltic mo- 
tion; for we find that every organ of the body in its healthy state, is 
sufficiently stimulated by its natural contents. The urine stimulates 
the bladder to contraction, and the blood the heart, whilst the sto- 
mach, the commencement of the alimentary canal, though in its na- 
tural and healthy state destitute of bile, is stimulated to all neces- 
sary action by the aliment we receive. To say, then, that the bile 
is the natural stimulus and cathartic of the bowels, explains nothing. 
To suppose that the liver is a chemical laboratory of drugs, necessary 
to the health and well being of the system, is derogatory to the func- 
tions and resources of the animal economy. We may presume, how- 
ever, that in a healthy state the bile answers an important part in the 
business of assimilation. The blood from which the bile itself is pre- 
pared is highly animalized, charged with hydrogenous and azotic 
principles, and consequently imparting an affinity of properties and 



76 Heustis on the Liver and Spleen, 

character to the secretions resulting therefrom. The greater the ad- 
mixture of animal juices and secretions, the more is the food approxi- 
mated to the nature of the body it is intended to support. This pro- 
cess is progressively taking place from the time the aliment is receiv- 
ed into the mouth, where it is mixed with the saliva, till taken up by 
the lacteals of the duodenum and jejunum, receiving in its progress 
the solvent and animalizing properties of the gastric fluid, the pan- 
creatic juice, the bile, and the secretion of the small intestines. But 
of all these secretions, next to that of the stomach, the probability is, 
that the bile is the most important. The saliva, gastric and pan- 
creatic juices appear to act principally as solvents of our food, whilst 
the bile by its mucilaginous, saponaceous, and highly animalized qua- 
lities, produces an intimate mixture and a conversion of the digested 
aliment into chylej "for it is demonstrably true," says Dr. Saun- 
ders, 'Hhat the digested matter does not assume a chylous form 
until it has passed below that part of the intestine where the biliary 
and pancreatic ducts make their entrance." A further use of the 
bile appears to consist in the antiseptic quality of its bitter and re- 
sinous principles, whereby it is disposed to resist the putrefactive ten- 
dency of the contents of the first passages, and by its alkaline pro- 
perty to correct the acetous disposition of vegetable aliment. These 
obvious uses of the bile, point out the propriety of artificial substi- 
tutes in those cases where this fluid is obstructed or deficient. 

It has been stated above that a portion of the bile was evidently 
excrementitious, and as such passed off by the bowels; and that one 
important office of the liver was to purify the blood from such gross 
and excrementitious matters as could not conveniently be eliminated 
by the lungs and kidneys. In the lungs the carbonaceous matters of 
the blood are thrown off in the gaseous state; in the liver the impuri- 
ties of the blood retain their fluid form, and constitute the biliary se- 
cretion; the function of the former is more simple, probably resem- 
bling that of the leaves of plants; that of the latter more elaborate and 
complex. To remedy or prevent the morbid tendency in the system, 
arising from the want of respiration in the foetus, as well as to assist 
in the important business of nutrition and assimilation, we find the 
liver disproportionably large; from its size, therefore, as well as from 
other considerations, it is not unreasonable to suppose, that even in 
the foetal state, this organ is subservient to some important office in 
the animal economy. Were the foetus a mere excrescence, no inde- 
pendent vascular arrangement and chylopoietic viscera would be ne- 
cessary to its growth and nutrition: for this purpose a mere continuity 
and extension of maternal nerves and vessels would suffice. But, be- 



Heustis on the Liver and Spleen. 11 

ing as it is, an independent system of its own, furnished with its ap- 
propriate organs, and these organs plentifully supplied with blood, 
and some of them, the liver for instance, with more than is necessary 
for their own growth and development, we are authorized to believe 
that in the latter instance, a function subservient to the nutrition 
of the system is supported ^and carried on, in the same way as is 
known to exist after birth. For though no nourishment may be re- 
ceived by the mouth of the foetus, yet the stomach and bowels are un- 
doubtedly furnished with their proper secretions, which, together 
with that of the pancreas and liver, may form a chylous assimilated 
fluid, fit for the purposes and nutrition of the foetal system. During 
the early period of pregnancy, before the visceral organization is suf- 
ficiently perfected, this function may be supposed to exist in a very 
inferior degree, but in the latter stage of utero-gestation, the rapid 
accumulation of meconium in the bowels shows that the liver is ac- 
tively concerned in the discharge of its important office, the purifica- 
tion of the blood, the assimilation of the fluids, and the secretion of 
bile. Haller supposed that the liver in the foetus was subservient to 
some other purpose than that of the secretion of bile, *' When I re- 
flect," says he, " that there is no bile required in the foetus, there 
being no food received^ when, again, I see that the liver is of great 
size in the foetus, and not small like the lungs, which are destined to 
an operation in the economy after birth, I cannot but suspect that it 
has some other use in the foetus than merely the secretion of bile." 
But if the view which I have taken of the subject be correct, it is not 
necessary to suppose that any other function in the foetal liver is ne- 
cessary, than that which is connected with its own appropriate secre- 
tion; and, therefore, that the same important office is performed by 
this organ before as after birth. It is undisputedly admitted that the 
hepatic artery is alone appropriated to the support and nutrition of 
the liver, and that the bile is secreted from the blood of the vena por- 
tarum. Such being the arrangement after birth, we can scarcely sup- 
pose that the blood of the umbilical vein in the foetus, as well as that 
of the vena portarum, would perform the slow and mazy circulation 
through the liver, and then pass into the vena cava^ in order to ar- 
rive at the right auricle of the heart, when a more direct communi- 
cation existed by the ductus venosus, were not some more important 
purpose concerned in this arrangement than the mere transmission of 
blood to the heart* 

In the fcetal state albumen is found in the small intestines, more 
particularly about the opening of the common duct of the liver into 

No. XL—May, 1830. 8 



78 Heustis on the Liver and Spleen. 

the duodenum, diminishing in quantity as we trace it towards the ter- 
mination of the ileum: no albumen, however, appears in the large in- 
testines, but, on the contrary, they are distended with a dark-green 
excrementitious fluid.* That the substances existing in the intestines 
of the foetus are not derived from the mouth, is proved by their being 
also found in acephalous children. In the foetus the lungs are small, 
shrunk, and undeveloped; they are here perfectly passive organs, and 
no more blood is transmitted to them, than is required for their own 
nourishment, and to preserve their vessels in a permeable state: all 
changes effected on the blood by the process of respiration after birth, 
has no existence here. And as the lungs in this state are dispropor- 
tionably small, so on the other hand, to remedy or prevent any noxi- 
ous impurity or carbonization of the blood arising from the want of 
respiration, we find the liver m the foetus disproportionably large. 
And this relation between the size of the organs holds, not only in 
the foetus, but in animals of different habits, nature, and modes of 
life. Thus, in those instances where the lungs are small, and their 
function limited and imperfect, the liver is of unusual size and de- 
velopment. It is presumable that the blood of the coeliac and mesen- 
teric arteries undergoes considerable changes in its distribution to the 
stomach, the intestines, the spleen, the pancreas, and the omentum; 
that on traversing these different regions very gradually, the carbon 
it contains unites with the oxygen and hydrogen, assuming a fatty 
character. It has been said,t that if this be the effect in man and 
quadrupeds, whose respiration is so perfect, in whose vessels the blood 
circulates with rapidity, it ought to be infinitely more marked in those 
animals which are able to live a long time in the mud or most infectious 
filth without breathing, and in whom, where respiration does take place, 
it is only in a very limited and imperfect manner, from the smallness of 
their respiratory organs, and from the consequent admission of a very 
small quantity of air. Such also is the case with fishes, more particu- 
larly the ray and the shark, whose gills are small, and whose blood is 
therefore slowly decarbonized. The size of the liver, therefore, and 
the quantity of bile are inversely proportioned to the size and perfec- 
tion of the lungs.:}: Thus, in those warm-blooded animals which have 
large lungs, and are always in the air, the liver, compared with the 
body, is proportionably less than in those which live partly in the wa- 



* Lee. Philos. Mag. also this Journal, for August, 1827, p. 480. 
■}■ Fourcroy. 

t Tiedemann and Gmelin. Edin. Med. and Surg. Journ. quoted in this Jour- 
nal, for Feb. 1828. 



Heustis on the Liver and Spleen. 79 

ter. Such being the relative function of the lungs and of the liver, we 
are enabled to understand why the quantity of venous blood sent 
through the liver should increase as the pulmonary system becomes 
less perfect. In man, the higher order of animals, and in birds, who 
live exclusively in the air, the blood furnishing the secretion of bile, 
is that alone which is returned from the abdominal viscera. But as we 
descend to animals of less perfect and efficient respiratory organs, 
the relative size of the liver, and the proportion of blood sent to it are 
considerably increased: in the tortoise, in addition to the veins already 
mentioned as going from the abdominal viscera to form the vena 
portarum, it receives also the blood of the hind legs, pelvis, tail, and 
vena azygos; in serpents it receives the right renal and all the inter- 
costal veins^ in fishes the renal veins, and those of the tail and geni- 
tal organs, also pass into the vena portarum. 

Most physicians have probably remarked the great increase of the 
biliary secretion which frequently attends pneumonic affections of 
the winter and spring, insomuch that the appellation bilious peri- 
pneumony, is often applied to this disease. The antagonizing rela- 
tion subsisting between the functions of the lungs and the liver, will 
explain this circumstance; for as in this disease the respiration is 
short, difficult, and impeded, so the blood is transmitted with less 
facility through the pulmonary vessels, and as a necessary conse- 
quence the decarbonization is less perfect; hence an increased quan- 
tity of escrementitious materials is throv/n upon the liver, and is se- 
creted in the character of vitiated bile. Though the bile in a healthy 
state may be useful and necessary in the process of chylification, we 
may still reasonably suppose that it is to a considerable degree excre- 
mentitious, from the considerations hitherto mentioned, as well as 
from the quality of the blood from which it is secreted. We find that 
all the other secretions of the body take place from arterial blood; 
whereas, the bile is secreted from that which has undergone the last 
degree of vitiation which it is capable of receiving on the living animal 
body. After having fulfilled the purposes of nutrition, and contributed 
to the other secretions of the system, and when it is no longer tit for the 
general purposes of the nutrition and expenditure of the body, it is sent 
to the liver, black, grumous, and loaded with impurities. It may be re- 
garded as an absurdity to suppose, that a fluid necessary in the process 
of chylification, should be secreted from blood of this description, and 
be also at the same time, to a considerable degree excrementitious; 
this, however, only serves to illustrate more strikingly the resources 
of nature, in being able to extract good out of evil; nor is it more sur- 
prising than that the industrious bee should extract honied sweets 



80 Heustis on the Liver and Spleen, 

from things offensive and disgusting. Johnson, in his Animal Che- 
mistry, speaking of the excrementitious nature of the bile, observes, 
" hence arises the necessity of this fluid being made with constancy 
and regularity, for the integrity of all the functions, and the reason 
of its existing in all animals, and of its being as necessary as the 
function of the lungs during respiration." To this circumstance of 
the bile being in a great degree excrementitious, may be ascribed se- 
veral other properties, viz. its nauseous and disagreeable smell and 
taste. It appears from the experiments of Fourcroy, that the oily 
part of the bile is merely in the state of spermaceti, but preserving its 
fluidity during a state of health. When, however, this matter is too 
abundant to remain in solution in the bile^ it becomes crystallized, 
forming calculi in the gall bladder, which, on analysis, evidently ap- 
pear to owe their foundation to this oily concrescible matter, which, 
being retained either in the pores or parenchymatous substance of the 
liver, often proves the source of several of its diseases. Thus, from 
the most impure blood, and such as many have supposed strongly dis- 
posed to putrescency, a fluid the most antiseptic of any in the body, 
is secreted. What effect the bitterness of the bile may have in resist- 
ing the putrefactive tendency of the faecal residuum in the bowels, 
we cannot positively say; but v^^e know that the faeces undergo a de- 
gree of putrefaction in the large intestines, and it is possible that the 
bile may check and retard this process. 

The function of the spleen is still involved in considerable obscu- 
rity. It would appear, however, from every consideration of the sub- 
ject, that its office in the animal economy, is, if I may so speak, 
merely negative. Thus, it furnishes no secretion, and the purified ar- 
terial blood that has just undergone the ventilation of the lungs, after 
circulating through it without any apparent object, is returned, in 
common with the blood from the other abdominal viscera, to the vena 
portarum. The blood, in its circulation through this viscus, mani- 
festly undergoes a change from arterial to venous, and in this manner 
becomes fitted for the secretion of bile. We can hardly suppose, 
however, from this circumstance, that the spleen is subservient to the 
function of the liver; for I have previously attempted to show that 
the office of the liver is to purify the blood, after it has been deprived 
of its restorative and nutritious properties, in its distribution to the 
alimentary canal and other abdominal viscera, and has become sur- 
charged with carbon and other noxious matters: and to suppose that 
the spleen answers no other purpose than that of vitiating the blood, 
in order to fit it for the secretion of bile, is to presuppose a most pre- 
posterous error and absurdity in the conformation of the system. It 



Heustis on the Liver and Spleen. 81 

has moreover been found, that the extirpation of this viscus, af- 
ter the re-establishment of health, has not been productive of anv 
change in the sensible or chemical qualities of the bile.* It is not 
agreeable to the economy of other parts of the system, to suppose that 
so large a quantity of blood as is sent to the spleen, is all required 
for its support^ for the splenic artery is large in proportion to the size 
of the viscus, and its vein is one of the principal branches of the vena 
portarum. The coats of its veins are very thin and yielding, and its 
substance loose, spongy, and distensible. That it is subject to sud- 
den engorgements of blood, and to vast and rapid increase in size, 
we have frequent proofs and examples. The structure and situation 
of the spleen, would, therefore, seem to point it out as intended for 
a guard to those important organs, the stomach and liver. Its artery, 
derived from the coeliac, the common trunk of the gastric, splenic, 
and hepatic, is conveniently situated to receive and transmit an in- 
creased impetus of blood. It is possible, however, that its agency and. 
function may extend to other remote and more general portions of the 
system; but if any benefit and safety should be derived in this way 
from it by the body generally, its effect, probably, is inconsiderable, 
compared with its more immediate subservience to the stomach and 
liver. Such a view of the function of the spleen, elevates it to a sta- 
tion of considerable consequence. It is well known how important is 
the relation which the stomach bears to other parts of the body; it be- 
ing on the healthy condition of this organ, that the soundness and in- 
tegrity of every other portion of the system so essentially depends, 
such is the intimate and sympathetic connexion of the stomach with 
the different and distant parts of the body, that when the former is 
disordered, the latter languish. A sick stomach enervates the mind, 
and relaxes and debilitates the body. Being itself, as it were, the 
centre and source of sympathy, it not only communicates its own suf- 
ferings to other parts of the system, but also participates in and re- 
ceives those of the latter. Such being its importance and general 
sympathetic connexion, it is not surprising that the ancients, imper- 
fectly acquainted as they were with the animal economy, should have 
considered it as the seat of the soul, or that Van Helmont should have 
made it the throne of his Archaeus, or presiding spirit. From the higli 
rank and distinction thus possessed by the stomach, we might, a jomn, 
suppose that extraordinary care would have been bestowed by nature 
to guard and protect it against any sudden and hurtful emergency, 
by securing it against dangerous congestion and unusual impetus of 

* See Saunders on the Liyer. 
8* 



82 Heustis on the Liver and Spleen. 

blood. The use and importance of the spleen in this way, may be in- 
ferred, if we turn our attention to numerous instances of autumnal 
fever which annually fall under our observation. In such cases, we 
find the spleen particularly involved in the general affection of the 
vascular system. This is more especially the case in the different 
grades and forms of intermitting and remitting fevers, characterized 
by the paroxysms commencing with a chill or ague more or less in- 
tense, of irregular and uncertain duration, and followed by a hot 
stage, which may or may not terminate by sweat. In fevers of this 
description, there is at the commencement of the paroxysm, a gene- 
ral shrinking and coldness of the exhalent and mucous surfaces^ the 
skin is cold and constricted, and the blood, the vivifying and calori- 
fic principle of animation, receding from the smaller vessels, a gene- 
ral sensation of coldness ensues. A similar state probably exists in 
the exhalent and mucous surfaces of the lungs and alimentary canal; 
hence the anxiety, sighing, and oppressed respiration, and the torpor 
and constipation of the bowels. But while the blood thus recedes 
from the smaller, it is accumulated in the larger vessels; hence the 
engorgements that are liable to take place in the abdominal viscera: 
it is in this way we explain the congestions and enormous enlarge- 
ments of the spleen, so frequently resulting from long protracted or 
often repeated attacks of intermitting or remitting fever. The struc- 
ture of the spleen being lax, soft, and easily distensible, admits freely 
an undue portion of the accumulated load thrown upon the abdominal 
viscera; and its contiguity to the stomach and liver, and the circum- 
stance of its deriving its blood from the same common arterial branch, 
diverts, in a considerable degree, the dangerous engorgement, which 
otherwise would take place to these important viscera. 

But, as previously stated, it is not the stomach alone that the spleen 
is designed to protect. The liver is also an organ of very consider- 
able importance, and one whose function is as often deranged from 
the influence of febrile causes as that of any other. The inflamma- 
tion of its membranous covering is marked by acute and painful 
symptoms, like that of other serous surfaces; but its parenchymatous 
or internal structure being less sensible, is often very seriously de- 
ranged by repeated or long-continued engorgements from exposure to 
malaria or from attacks of fever, without betraying its condition by 
any particular pain or uneasiness. But we have here other symp- 
toms to guide us, afforded by the state of the stomach and bowels, the 
appearance of the discharges, the complexion, &c. We have already 
attempted to show the great importance of the function performed by 
the liver in the animal economy. To protect an organ of so much 



Heustis on the Liver and Spleen. 83 

consequence to the health and integrity of the general system, may 
we not therefore reasonably suppose that the spleen occupies an im- 
portant station? 

From the causes above mentioned, we often find the spleen enor- 
mously enlarged, sometimes apparently occupying nearly the whole 
extent and circumference of the abdomen, producing certainly by its 
size and weight inconvenience in the movements of the body, and by 
compression of the neighbouring viscera and blood-vessels, perhaps 
giving rise to hydropic symptoms; this effect I have known to be pro- 
duced by it, though not generally to an alarming or dangerous extent. 
Where the spleen is thus enlarged, however, the person seldom en- 
joys good health; he appears lean, sallow, and cachectic; a slow insi- 
dious febricula attends him, though his appetite is often keen and 
voracious, and his mind fails him upon slight exertion. What, how- 
ever, would be the consequence were any other viscus thus surcharged 
and overstrained beyond its natural capacity? Total disorganiza- 
tion of the part, or death of the individual would speedily ensue. 
But in the peculiarity of structure possessed by the spleen, there 
seems to be scarcely any definable limits to the degree of enlarge- 
ment, and we accordingly find that it still goes on increasing as long 
as the cause which first produced it continues to act. This, although 
it may be considered as an alternative of evils, is yet greatly on the 
side of advantage to the patient, a lesser evil to prevent a greater. 
Instead, therefore, of repining that man's organization was not made 
more perfect, conferring an immunity from disease and infirmity, 
should not rather our gratitude and admiration be excited at the good- 
ness and wisdom of the Creator, in affording so many means of pro- 
tection against the diseases and accidents which assail and beset us? 

I think it may be safely affirmed that the nervous is more influenc- 
ed by the vascular system, than the latter is by the former. Thus, 
violent pains and spasms may exist without disordering the action of 
the heart and arteries, but no sooner are the latter disordered, than 
the whole nervous system becomes tofa greater or less degree affect- 
ed. Now the remote causes of fever in all probability operate prima- 
rily upon the vascular, and secondarily upon the nervous system. 
In the cold stage of fever there is a shrinking of the smaller vessels, 
and the blood evidently recedes from them, the pulse is weak and 
small, the skin shrunk and cold, and the bowels torpid. But as no 
loss of blood has taken place, whilst it has evidently receded from 
the smaller vessels, it must consequently be accumulated in the larger 
trunks. Such an accumulation presupposes reduced strength and 
vigour in the action of the heart and arteries, in consequence of which 



84 Heustis on the Liver and Spleen. 

the blood accumulates at the right side of the heart, and venous con- 
gestion takes place, more especially in the brain, the vena cava, and 
the portal system. But though the blood in these vessels is thus ren- 
dered slow and sluggish in its motion, we can hardly suppose that 
there is an actual arrest or suspension of its movements, for as long 
as the arteries continue to act and pour forth blood, it must continue 
to be returned by the veins, although a degree of distention may take 
place in consequence of impeded action. But in instances of this 
nature, as previously observed, the spleen appears to be the great re- 
servoir of blood, to guard against the total inundation and destruction 
which might otherwise take place in parts and viscera more essential 
to vitality. As the structure of this viscus is diflferent from that of 
any other organ of the body, as its vessels as well as its substance are 
lax, yielding, and distensible; as it performs no active duty, nor fur- 
nishes any secretion, its engorgement deranges no function, whilst at 
the same time a flood-gate is opened for the protection of other im- 
portant organs. 

It has h^^n supposed by a late European writer on tropical dis- 
eases. Dr. James Johnson, that the hepatic system is affected by 
sympathy with the surface of the body, in the following manner. The 
extreme vessels on the surface of the body, and by sympathy of the 
vena portarum in the liver, having been excited into inordinate ac- 
tion during the intense heat of the day, and suddenly struck torpid 
by the raw, damp, chilling land winds; the consequence of which is, 
that the perspiration and the biliary secretion are checked, the blood 
determined inwards is impeded in its passage through the liver, and 
accumulation ensues in the portal arch, which is immediately com- 
municated to the brain. During this period, the bile stagnating in the 
biliary ducts, becomes viscid; and on the recommencement of a hur- 
ried secretion, from emetics or other remedies determining the blood 
to the surface, often so obstructs the natural passage into the intes- 
tines, that regurgitation into the circulation takes place and tinges 
the skin yellow. A great deal, however, is forced up through the 
stomach in a viscid and vitiated state, tending to keep up the gastric 
irritability, and sometimes to destroy the stomach altogether. He 
thinks this explains why the men were all seized in the night, and 
why a nocturnal exacerbation was ever afterwards observed. "With 
strict justice, therefore," says Dr. Johnson, "and with more pro- 
priety we might denominate the fever in question hepatic rather than 
bilious fever ^ and with some slight modification, principally in de- 
gree of violence, I shall show, in a future section, that in reality it is 
alter et idem hepatitis itself." If it is contended that diseases of the 



Heustis on the Liver and Spleen. 85 

liver and increased secretion of bile, so frequent in hot climates, are 
owing to sympathy between the hepatic and cutaneous vessels, I 
would ask why may we not suppose the existence of a similar sympa- 
thy and correspondence of action between the skin and other inter- 
nal organs; for instance, the kidneys? But here we find, on the con- 
trary, the secretion of urine diminished in proportion to the increase 
of the perspiration. To make an exception in favour of the liver, 
and to say that it follows a law directly opposite to that which favours 
the secretion of urine, appears to be advancing a proposition without 
just and satisfactory grounds and arguments to support it. It is a 
well known fact that the secretion of bile is increased in warm 
weather, but to say that this is owing to sympathy with the skin ap- 
pears a mere gratuitous assumption. Were this the fact, labourers, 
even in healthy climates, during the summer season would be seized 
with diarrhoea or cholera as often as their skins became bathed in 
sweat, and the effect upon residents in hot climates would be conti- 
nued and speedily overwhelming. The argument drawn in support 
of this hypothesis from dyspeptic, chlorotic, and diabetic patients, in 
whom a dry skin and a deficient secretion of bile are often observed, 
is entitled to but little weight or consideration, as proving nothing 
more than that there is a general deficiency in the healthy secretions 
of the body. And it remains yet to be shown that indolent and se- 
dentary persons in hot climates, in whom the perspiration is necessa- 
rily less, are, therefore, less liable to redundancy of bile than those 
who follow laborious employments. 

It is a little surprising that the author above alluded to, after at- 
tempting to prove the sympathy existing between the secretion of bile 
and perspiration, should advance a fact in direct contradiction to his 
own hypothesis, and be under the necessity of having recourse to the 
agency of cold to assist him in his argument. The fact adduced, i& 
that mentioned by Sir James M'Gregor, that during the march of 
the army over the sandy desert of Thebes, when the thermometer 
frequently stood at 118° in the soldiers tents, the health of the troops 
was equal to what it had been at any former period in India. He 
therefore infers that heat is not the principal cause of the prevailing 
diseases. "It certainly is not," says Dr. Johnson, ''but when ex- 
cessive and long-continued, it induces that state of the vessels on the 
surface and of the liver, which is easily thrown into disease by the 
sudden application of a slight degree of cold." Here then we have 
heat producing an increased secretion of bile, but no disease or in- 
convenience resulting, and only throwing the system into a morbid 
state by the subsequent application of cold, or, to speak more intelU^ 



8'6 Heustis on the Liver and Spleen. 

giblj, by subsequent exposure to a reduction of temperature some- 
what below that which gave rise to the increased secretion. The 
operation of cold is explained bj the same author, in the following 
manner: "Not onlj is the animal heat too rapidly abstracted, but the 
extreme vessels on the surface, and likewise those of the vena porta- 
rum are instantly struck torpid, the perspiration and biliary secretion 
are arrested, the passage of the blood through the liver is obstructed, 
and a temporary congestion throughout the portal circle is the result." 
This explains the philosophy of the practice of the physicians pre- 
viously to the days of Sydenham; which was by artificial heat to pre- 
vent the vessels of the vena portarum from being struck torpid. This 
view of the subject would also seem to demonstrate the danger to be 
apprehended from the modern practice in fevers, of bleeding and the 
cooling regimen, and the importance and absolute necessity of main- 
taining a high temperature in order to prevent the blood from stag- 
nating in the liver. But, according to this h^'pothesis, how does it 
happen that the inhabitants of elevated and dry situations in tempe- 
rate as well as in intertropical climates, are not equally subject to hepa- 
tic diseases as well as those who live in the vicinity of rivers and 
marshes? The former are equallj^ subject to the vicissitudes of tem- 
perature as the latter, and a cool night or a shower of rain should be 
equally productive of hepatic diseases, diarrhoea and cholera in one 
situation as the other, but general observation and experience prove 
that such is not the fact. What then becomes of the theory of Dr. 
Johnson.^ 

Among the remote causes of hepatic diseases, in hot as well as in 
temperate climates, may be mentioned sedentary and inactive habits, 
and tlie too free use of spirituous liquors. The influence of inacti- 
vity in producing visceral disorders may be explained by sundry con- 
siderations; in the first place, a general debility is induced as well of 
the muscular as of the vascular system; in consequence of this debi- 
lity the blood circulates with less force through the liver, and hence 
congestion and permanent obstruction may take place. It is in this 
way, as connected with and resulting from visceral obstructions and 
enlargements, that we may explain the ill health, short lives, and 
sudden deaths of so many scholars and philosophers who have en- 
riched, enlightened, and benefited the world by their recluse and so- 
litary labours. A remora of blood takes place in the many convolu- 
tions of the liver, and obstructions and morbid enlargements follow 
as the necessary consequence. In this way that philosophical painter, 
Sir Joshua Reynolds, fell an untimely sacrifice to his unwearied as- 
siduity and devotion. To him a minute unprofitably or rather use- 



Heustis on the Liver and Spleen. 87 

lessly mispent, was a loss irreparable and a melancholy blank in the 
sum and history of his life. Had he been aware, however, of the ra- 
pid inroads which an insidious disease, arising from his sedentary oc- 
cupation, was making upon his health and constitution, he might have 
found that a little prodigality of life in wholesome exercise and re- 
laxation, would have been his greatest gain and the surest means of 
protracted and permanent enjoyment. In persons who use but little 
exercise, there is but little expenditure of strength or substance, in 
consequence of which there is often an undue accumulation of fat both 
within and upon the surface of the body. This accumulation has the 
effect of still further impeding the circulation, as maybe observed in 
all inflammatory diseases affecting corpulent persons, so that the vas- 
cular obstruction keeps pace with the accumulation of adipose mat- 
ter in the cellular membrane. In this way we may account for the 
premature death of that astonishing man, who for many years held 
all Europe in awe and apprehension, and even terrified the British 
lion. His whole life had been a scene of activity and exertion, the 
short but profound studies and reflections of his closet or his pillow 
were followed by a world of corporeal industry and toil. Can we 
wander then, that, confined to a solitary rock in the midst of the wide- 
spread ocean, that he who grasped the world in his imagination and 
sighed for universal empire, should soon experience the morbid influ- 
ence and eftects arising from the disuse of that corporeal and mental 
exertion to which he had hitherto been accustomed.^ His gigantic ge- 
nius was humbled to the dust, and gloom, melancholy, and despair 
took possession of his mind, and preyed upon his body. 

As connected with the remote causes of hepatic and glandular ob- 
structions, I beg leave to introduce a few remarks with respect to 
the operation of spirituous liquors. In the soft and spongy texture 
of the parenchymatous substance of the liver and spleen, the vessels, 
from the delicacy of their structure, and from their mazy convolutions, 
are liable to become enlarged and distended upon every preternatural 
increase in the action of the sanguiferous system, whereby debility and 
derangement of their function ultimately ensue. Without, therefore, 
supposing any thing peculiar in the operation of spirituous liquors b}' 
which they may be particularly disposed to affect the biliary organs, 
the diseases to which they are liable from the use of those liquors 
may be accounted for from the frequent excitement and over-stimu- 
lation produced by repeated fits of intoxication^ but if at the same 
time we conclude that the liver is affected in a degree proportionate 
to the quantity of biliary and excrementitious matters existing in the 
circulating fluids, and that spirituous liquors have a tendency to pro- 



B8 Heustis on the Liver and Spleen. 

duce such vitiation, we shall perceive that in this way ardent spirits 
have a secondary influence besides that of producing a temporary ex- 
citement in the sanguiferous system. In this manner, from frequent 
congestions and the inordinate stimulus applied to it, this organ be- 
comes at length preternaturally enlarged or scirrhous in its sub- 
stance, and debilitated and paralyzed in its action.* 

But to resume the subject of atmospheric temperature, it may be 
remarked, that heat alone, though alternating with cold, is not ca- 
pable of producing any thing like an epidemic disease, or of occa- 
sioning derangement in the function of the liver. For this purpose it 
is necessary that there should be a morbid condition of the atmo- 
sphere, arising from the extrication of miasmata, or from causes less 
obvious to the senses, but at the same time disconnected, as an effi- 
cient agent, with the temperature of the air. For, as previously re- 
marked, we often find fever prevailing in sandy places, whilst others, 
in the same vicinity, equally subject to the vicissitudes of heat and 
cold, are entirely exempt from disease. That heat has a remote and 
important agency in the production of the endemic diseases of tropi- 
cal, as well as temperate climates, is not denied; for its influence in 
this way is too well ascertained to admit of contradiction; but then it 
is necessary that there should exist corruptible materials for it to ope- 
rate upon, before it can give rise to epidemical diseases. It is well 
known that those who live on board of ships in hot and unhealthy 

* But although the liver and spleen are the principal sufferers, they are by no 
means the only parts that experience the pernicious operation of spirituous 
liquors. There is scarcely a gland, viscus, or vessel of the body, that is not in- 
jured in a greater or less degree from their protracted and habitual use. Hence, 
by their debilitating and atonising influence upon the body generally and par- 
ticularly, they lay the foundation for gastritis, enteritis, phrenitis, ophthalmia, 
pluritis, splenitis, hepatitis, nephritis, and diabetes. At the same time they 
produce a state of torpor and paralysis of the lacteal and lymphatic systems; 
the mesenteric glands become torpid, inflamed, obstructed, and proceed to sup- 
puration; hence the chyle is prevented from passing into the circulation, and 
atrophia and tabes follow. From the general debilitated state of the sanguife- 
rous and lymphatic systems, the legs become oedematous, erysipelatous, op 
ulcerated, and from the same cause, together with the enlargement of the liver 
and spleen, general dropsy is apt to ensue, whilst the abundant secretion of bile 
gives rise to jaundice, biliary concretions, colic, and cholera. Their enervat- 
ing influence occasions palpitations, syncope, tetanus, palsy, impotency, pre- 
mature decay, decrepitude and old age. Their operation on the brain and 
nervous system produces melancholy, mania, and fatuity. They also give oc- 
casion to inflammation and obstruction in the lymphatic and conglobate gland* 
of the lungs, and impair the functions of those vital organs. 



Heustis on the Liver and Spleen. 89 

countries, at a sufficient distance from the land, are not affected with 
the prevailing endemic of the climate, whilst those, on the contrary, 
who visit the shore, and remain over night, become, almost inevita- 
bly, the subjects of disease. Dr. Hunter, in his account of the dis- 
eases of Jamaica, remarks, that the heat of tropical climates, though 
generally represented as the cause of their unhealthiness, will not 
alone produce fevers; and instances in proof, the circumstance of 
those inhabitants who live on dry and sandy spots, along the coast, 
where, although the heat is unusually great, there is a complete ex- 
emption from tropical diseases. 

Too much water, or too great dryness, are both unfavourable to the 
extrication of noxious miasmata. It is well known, for instance, that 
substances in a state of dryness, remain free from corruption. A con- 
stant supply of, or submersion in fresh water, also very much retards 
decomposition. It is well known that the circumstances required for 
the decomposition of dead animal or vegetable substances, are heat, 
moisture, and exposure to the atmospheric air. The temperature most 
favourable to the process, seems to range between 75° and 95° of 
Fahrenheit. A higher degree of heat, by dissipating humidity, im- 
pedes or suspends the process. The degree of heat necessary to pu- 
trefaction is much lower than that which is required for spirituous 
or acetous fermentations, for putrefaction takes place at the tempera- 
ture of 45°; but a higher temperature is still more favourable, at least 
if the heat be not so violent as to volatalize and dissipate the mois- 
ture of the putrescent substance, and render it entirely dry. Access 
of air is another circumstance especially favourable and necessary for 
putrefaction, for it is found that vegetable substances are preserved 
in vacuo. 

In purifying the atmosphere, gusts of wind and showers of rain 
have considerable influence, by precipitating and dispersing noxious 
miasmata, and thereby giving a check to the rise and prevalence of 
disease. 

«'Itis commonly asserted," says Assalini,* "that the heat in 
Egypt puts a stop to the plague, whilst it makes it break out in Con- 
stantinople." He accounts for this difference in the followino- man- 
ner. At Constantinople, the exhalations from various bodies, in a 
state of putrefaction, are very copious during summer; the cold of 
winter prevents their formation, and the disease ceases. In Egypt, 
on the contrary, the action of the sun is very powerful, even during 
winter, and gives rise to noxious exhalations. When the low grounds 

* Assalini on the Disease called the Pla^e, &c. Amer. edit. p. 72. 
No. XL— May, 1830. 9 



90 Heustis on the, Liver and Spleen. 

have become dry, which happens in the month of Nisedor, (in June, at 
the festival of St. John,) then the coast of Lower Egypt becomes as 
healthy as the rest of that fine country. It is remarked by the na- 
tives on the coast of Coromandel, and the observation is confirmed 
by the experience of many Europeans, that the longer the hot land 
winds continue to blow, the healthier are the succeeding months; 
agreeably to their opinion, these winds purify the air. The inquiry 
is made by Dr. Lind,* whether these winds are not the cause why the 
air on the coast of Coromandel, except during their continuance, is 
more healthy than other parts of India, where these winds do not 
blov/^ and whether this does not suggest a very probable reason why 
the plague in Egypt generally ceases about the beginning of June; the 
periodical hot winds, that come from the deserts of Nubia and Ethi- 
opia, having then rendered tlie air in Egypt pure and wholesome. 
The fact of the hot winds, as they are properly called, putting a stop 
to the plague in Egypt, is confirmed by the generality of travellers 
who have made observation on the subject. t After the 24th of June, 
the plague, however great may have been its ravages, ceases in Egypt. 
After that day, there is seldom an instance of any person being at- 
tacked by that disorder. Some have attributed this to the overflowing 
of the Nile, others to the prevalence of the north wind; but it is pretty 
clearly ascertained, that the plague generally ceases before any in- 
crease of the Nile is perceptible, and before the commencement of the 
north wind. And Mr. Antes has shown from authentic facts, that 
any extraordinary degree of heat, even at an earlier season, produces 
a similar effect. 

A certain degree of moisture is indispensably necessary for decom- 
position. When animal bodies are suddenly deprived of their humi- 
dity and aqueous juices, they become hard, dense, and incorruptible, 
like petrifactions. This is exemplified in the arid and sandy deserts 
of Egypt and Arabia, and also in some parts of South America, where, 
notwithstanding the heat of climate, the dryness of the atmosphere 
and soil prevents putrefaction, by the rapid exsiccation of the animal 
juices which it occasions. By an increase of caloric, the quantity of 
water which the atmosphere is capable of holding in solution, is also 
increased. Now, the air in passing over these parched and sandy de- 
serts, where there are no trees, herbage, nor aqueous exhalations to 
refresh it, becomes intensely heated by the scorching sun, so that its 
capacity for water is greatly augmented; from which circumstance, 

* Lind on the Diseases of Hot Climates, p. 47. 

f Antes' Observations, p. 45. Brown's Travels, p. 360. 



Heustis on the Liver and Spleen. 91 

a robs every thing of humidity which is capable of affording it, and 
animal bodies are converted into mummies. We are informed by the 
learned Dr. Shaw, in his Travels from Egypt to the Holy Land, that 
he saw in the deserts, the bodies of some dead camels, which had be- 
longed to a former caravan, and remaining in a state of preservation 
entirely free from putrefaction. It is, perhaps, more to the dryness 
of the air and soil, than to any art of embalming, that the preserva- 
tion of those human bodies, called Egyptian mummies, are owing. 

The destruction of caravans and travellers in the deserts of Asia 
and Africa, is frequently caused by the fatal breeze called the Samiel 
wind, a blast of which, in those parched deserts, proves instantly fa- 
tal to the unfortunate traveller or beast that may be exposed to it. 
These winds seem to produce death by suffocation, in consequence 
of their depriving the lungs of the ability to perform their function, 
and not by any pestilential poison in the air itself. It appears from 
the experiments of Dr. Priestly, that oxygen gas will not act upon 
the blood through dry membrane, and that a moist state is necessary 
for this purpose. The dry and parched air of these sandy deserts, in- 
stantly absorbs the moisture from the delicate membrane forming the 
air-cells of the lungs, and thereby prevents the oxygen of the atmos- 
phere from performing its purifying operation on the blood. The 
effects of this air upon the surface of the body are similar to those 
upon the lungs; it shuts up the pores of the skin, and puts an entire 
stop to the perspiration. These reflections were made previously to my 
seeing those of Mr. Volney upon the same subject, who says, in his 
description of the Camsin, (which may be considered the same as 
the samiel,) "the lungs are irritated by the presence of this air, are 
contracted, and rendered crisp. This wind crisps the skin, evapo- 
rates animal moisture, closes the pores, and produces febrile heat, 
which always accompanies suppression of the perspiration." The ef- 
fect of this hot suffocating blast, or vapour, says Dr. Lind, on the 
human body, even when mitigated bypassing through a moist atmos- 
phere, is the same as that of intense cold; it shuts up every pore of 
the skin, and entirely stops the perspiration of such as are exposed 
to it. They come on only in the day time, and always from the de- 
sert. Water is the only known antidote or corrector of this vapour. * 
It appears from the experiments of Saussure, that a cubic foot of at- 
mospheric air will hold eleven grains of water in solution. A certain 
degree of humidity is necessary to preserve substances upon the sur- 

* Lind on Hot Climates, p. 144, 



92 Heiistis on the Liver and Spleen. 

face of the earth in a proper state of moisture and pliability. During 
a season of the year, the wind called the Harmattan prevails in the 
interior of Africa, which is so extremely dry, from passing over the 
sandy deserts, that furniture of houses is destroyed by it, the floors 
and joints of buildings are laid open, and the scarf skin on the sur- 
face of the human body is rendered crisp and peels off. We are in- 
formed by Wafer, an English surgeon, that he and some others, 
landed at Vernugo, in South America, in 1687, and marched about 
four miles up a sandy bay; " all which," he says, " we found cover- 
ed with the bodies of men, women, and children, which lay so thick, 
that a man might, if he would, have walked half a mile, and never 
trod off a human body. These bodies, to appearance, seemed as if 
they had not been a week dead; but if you handled them, they prov- 
ed as dry and light as a sponge, or a piece of cork." It appeared upon 
inquiry that this was once a large and populous city, called Wormia, 
inhabited by Indians, and that upon the invasion of the country by the 
Spaniards, the inhabitants, rather than be at the mercy of their savage 
enemies, dug holes in the sand, and buried themselves alive. " The 
men," says the above-named author, *'as they now lie, have with, 
them their broken bows, and the women their spinning-wheels and 
distaffs, M'ith cotton yarn upon them."* This account, with other in- 
stances and particulars of a like nature, is confirmed by Fuzier, a 
French voyager, who was in Peru in 1712.t 

* Voyage and Description of the Isthmus of America. 

f A striking- and remarkable instance of the power of cold in preserving ani- 
mal matter is given by Professor Cuvier, as taken from a report in a supplement 
to the Journal du Nord, No. 80, by A. Adams, adjunct member of the Academy 
of Petersburg. It is a notice of the discovery of the body of a large animal, 
which was discovered in the year 1799, by a Tongusian fisherman, projecting 
from an ice bank, near the mouth of a river in the north of Siberia. In the sum- 
mer of 1803, the fifth year of this discovery, the enormous carcass became en- 
tirely disengaged, by thawing, and fell down from the ice crag on a sand bank, 
forming part of the coast of the Arctic Ocean. Two years afterwards, or in 
1806, Mr. Adams went to examine this animal, which still remained on the sand 
bank, where it had fallen from the ice, but its body was then greatly mutilated, 
in consequence of the depredations of the inhabitants of the neighbourhood, 
the Jakouts, who had taken away great quantities of its flesh to feed their dogs, 
and the wild animals, particularly the white bear, had feasted on the carcass. 
The skin was extremely thick and heavy, and as much of it remained as re- 
quired the exertions often men to carry away. More than thirty pounds of the 
hair and bristles of this animal were gathered from the wet sand bank, having 
been trampled in the mud by the white bears, while devouring the carcass, As 



Heustis on the Liver and Spleen. 93 

Excess of, or submersion in water, is also unfavourable to decom- 
position. Dr. Dazille, in his treatise upon the diseases of the ne- 
groes in the West Indies, informs us, that the rainy season is the 
most healthy at Cayenne, owing to the neighbouring morasses being 
deeply overflowed. It is related of Erupedocles, the Sicilian philo- 
sopher and poet, that he put a stop to pestilential diseases among the 
Salacenti, by turning two streams of good water into the morass from 
which they originated. It is well known that the overflowing of the 
Nile puts a stop to the plague in Egypt, by covering the low grounds, 
and preventing the progress of putrefaction in the alluvial matters 
which lie upon the surface of the earth. The letting out of water 
from the fosses of fortified towers, has produced malignant remittents, 
and the letting it in again has put a stop to their progress. Sir John 
Pringle, speaking of the diseases of Flanders, where from the low, 
damp, and swampy situation, intermitting fever is the prevailing 
complaint, observes that when the heat comes on soon, and continues 
throughout autumn, not moderated by winds and rains, the season 
proves sickly, the distempers come on early, and are dangerous; but 
when the summer is late, and tempered by frequent showers and 
winds, or if the autumnal cold begins early, the diseases are few, 
their symptoms mild, and their cure easy. For in marshy grounds, in- 
tense and continued heats, even without rain, occasion much mois- 
ture by the exhalation which they raise and support in the atmosphere; 
whereas, frequent showers during the hot season, cool the air, check 
the rise of vapours, dilute and refresh the corrupted water, and pre- 
cipitate noxious effluvia. We are informed by the same author, that 
the inhabitants of Breda, during the season of bilious fevers, secure 
themselves from the noxious exhalations of a piece of marshy ground 
in its vicinity, by overflowing it with water. It is stated by Purchas 
that five hundred persons less died of the plague, the day after the Nile 
overflowed the ground which had emitted the putrid exhalations that had 
produced it, than had died the day before. The manner in which the 
inundation of marshy grounds prevents the extrication of noxious ex- 
halations, is not so much by the exclusion of air, for water is always 
saturated with atmospheric air, as by keeping the temperature of the 
surface below the degree necessary for speedy decomposition. As 
the particles of water heated by the sun's rays are specifically lighter 

this must have belonged to a race of animals at present extinct, and of which 
no account is given in natural history, it is probable that this carcass might have 
been preserved in this block of ice some thousands of years previously to its 
discovery. By what accident it became placed in this situation, is not the ob- 
ject of the present inquiry to investigate. 

9* 



94 Heustis on the Liver and Spleen. 

than those beneath, it of course is physically impossible that they 
should descend, so as to impart their warmth to the subjacent stra- 
tum, as long as they retain this disproportionate superiority of tempe- 
rature; so that when the water is deep, the bottom must always re- 
main unaflfected by the heat of summer, and will consequently con- 
tinue cool while the surface is warm; and in this way decomposition 
is prevented from taking place in the subjacent mass of vegetable 
and animal matter. Where, however, a thin sheet of water only is 
spread over the surface of the soil, the whole body of fluid becomes 
heated by the sun, and decomposition takes place with as great, or 
even greater facility, than in those places where no stagnation of wa- 
ter occurs. 

From what has been already advanced, it would appear that the 
principles of vegetation and the causes of fever are intimately con- 
nected, and so closely and inseparably allied as to render it highly 
probable that there is a similarity if not an identity in the nature and 
causes of both. We know that in general where the principles and 
requisites of a luxuriant vegetation exist in the greatest abundance, 
there also fever, as an endemic, is apt to prevail. Heat and mois- 
ture are essential to putrefaction, and the consequent production of 
vegetable growth. These circumstances are the most conspicuous in 
the low and marshy situations of hot and tropical climates, along the 
margins of rivers and creeks, and near ponds of stagnating water; in 
such places endemic fever also occurs, whilst even in the same re- 
gion, where the country is high and dry, and in hilly situations above 
the reach of inundations and the miasmata of the low grounds, 
swamps, and water-courses, fever, as an endemic, is scarcely known; 
much less in cold and northerly climates, similarly situated with re- 
spect to elevation and dryness. It has been remarked by that judi- 
cious and accurate observer. Dr. Robert Jackson, that the rise and 
progress of endemic fever are evidently connected with the different 
periods of the season. In spring the principle of vegetation is ex- 
tricated in great quantity, while the capacities of plants are still 
small; an excess is consequently generated, and this excess extends 
its influence to a certain distance around. In summer the extrication 
of the principle still increases, but the capacities of plants having ex- 
tended in a greater proportion, the means are more adequate, and the 
excess is actually less. In autumn the growth of plants being com- 
pleted, while the causes still continue to produce a great extrication 
of the principle of vegetation, the excess abounds and escapes in a 
wider circle. 

With respect to the physical world one striking peculiarity of hot 



Heustis on the Liver and Spleen^ 95 

and tropical climates is the vast luxuriance of the vegetable kingdonig 
and the countless myriads of animated beings. All nature teems 
with life. Wherever the land is fertile, but especially near the 
rivers and water-courses, the oak, the poplar, the ash, the beech, 
the gum, (nyssa and liquidamber,) the lynn, the sycamore, the 
hickory, &c. uniting their branches, make a dense shade, impenetra- 
ble to the noonday sun^ in addition to which, the variety of vines, 
shrubbery, and undergrowth form a matted thicket, in many places 
almost impassable to the wild beasts which they shelter and protect 
The plants of the summer wither and die with the cold of winter, but 
no sooner does spring recall the warm and genial breezes of the south, 
than nature starts into renovated bloom and verdure. Mounting the 
loftiest trees, the vines, which lately appeared like the ropes and 
cordage of a navy, soon cover the woods with their luxuriant foUagei 
the late lanes and opening vistas of the forest are closed and obstruct- 
ed to the searching eye; a deep and melancholy gloom gives an as- 
pect of solemnity and awe to the uncultivated wilds. Not a foot of 
ground is left unoccupied; the spaces aftbrded by the larger trees are 
filled up by those of smaller growth, and vines, bushes, briars, weeds, 
and shrubbery of different descriptions contend for the remainder; to 
all which add the swarms and multitude of flies, mosquitoes, bugs, 
and smaller insects which find a continent in every leaf, lizards, 
reptiles, beasts, birds, and smaller animals, which seek the shady 
covert of the woods, and some notion may be conceived of the proli- 
fic nature of a southern clime. From this view of the subject it must 
be evident that the progressive extinction and decay of animate and 
inanimate substances, must, when operated upon by a summer sun, 
occasion a proportional degree of decomposition, and the consequent 
production of disease. Yet, by the industrious and judicious hand of 
cultivation, these otherwise noxious matters may be disarmed of their 
baneful influence, and made subservient to the comfort and neces- 
sities of man. Sir Humphrey Davy, in his lectures on agricultural 
chemistry, has some useful observations on the subject of decomposi- 
tion as applicable to manures. ^'The doctrine of the proper appli- 
cation of manures from organized substances," says Sir Humphrey, 
*' offers an illustration of the economy of nature, and of the happy 
order in which it is arranged. The death and decay of animal sub- 
stances tend to resolve organized forms into chemical constituents, 
and the pernicious efiiuvia discharged in the process, seem to point 
out the propriety of burying them in the soil, where they are fitted to 
become the food of vegetables. The fermentation and putrefaction 
of organized substances in the free atmosphere are noxious processes, 



96 Heustis on tha Liver and Spleen* 

beneath the surface of the ground they are salutary operations. In 
this case the food of the plant is prepared where it can be used, and 
that which would offend the senses and injure the health if exposed, 
is converted by gradual processes, into forms of beauty and useful- 
ness5 the fetid gas is rendered a constituent of the aroma of flowers, 
and what might be poison becomes nourishment to animals and to 
man." It is thus that provision has been made for the regeneration 
of the fallen leaves, which lie scattered and rot upon the ground, 
and which, to an ordinary observer, would appear to be lost for ever. 
Itappearsfrom the experiment of Berthollet, that whenever the soil 
becomes charged with the corruptible and decaying materials of ani- 
mal and vegetable growth, the oxygen of the atmosphere combines 
with the mouldering mass, and converts it into carbonic acid gas, the 
food and nourishment of growing plants. In this manner it is, that 
by the products of putrefaction the animal and vegetable creations 
are renewed. Nothing is lost by death; it is but a change of condi- 
tion, a transmutation of matter. From the mouldering ruins of de- 
parted life a new growth arises into existence with all the grace and 
beauty of renovated youth, and thus the metempsychosis of animal 
and vegetable beings, as likewise the ancient fable of the phoenix 
emerging into life from her parental ashes, is chemically true. 

As the endemic fevers of warm climates are produced by heat 
operating upon corruptible materials, it is obvious that wherever the 
essential causes, heat, moisture, and corruptible materials exist in 
the greatest degree, there will bilious and endemic fevers prevail 
with the most malignant fatality. Such being the facts, we find that 
the bilious remittent fever is the natural offspring and production of 
a widely extended country, comprehending in its circle the torrid 
and a considerable portion of the temperate zones; viz. Africa, the 
East and West Indies, the South of Europe and Asia, a considerable 
portion of South America, and its extent and prevalence in various 
parts of North America are too well known to require to be particu- 
larly mentioned here. The more temperate or cool the climate, the 
less subject will it be to bilious fever, and on the contrary, the hotter 
the climate, and the more marshy and abundant in putrefying mate- 
rials, the more subject will it be to this disease. These are truths 
which may be said to be as immutable as the laws of nature. Was 
the yellow or bilious fever ever known to exist in the frigid zone.^ in 
Lapland, Sweden, Norway, Denmark, or Greenland? No; and for 
very obvious reasons, because the heat of those countries is never 
sufficiently great or long-continued to produce the necessary degree 
of putrefaction and decomposition. As W6 approach the equator, 



Heustis on the Liver and Spleen. 97 

we observe the disease more frequent and malignant, until arriving 
at the tropics, we there find it existing as an almost permanent en- 
demic. 

It is remarked by the celebrated Zimmerman, that exhalations 
from marshes do not seem to be so noxious in cold as in hot countries, 
yet malignant fevers occur, as in Zealand, In Germany these exhala- 
tions produce tertians, in Hungary petechial fevers, in Italy the he- 
mitritace, and in Egypt and Ethiopia pestilential fevers. 

It would be a curious and interesting subject of investigation to 
trace the gradually increasing malignity of endemic fever from the 
northern boundary of the temperate to the torrid zone. "VVe should 
find, that other circumstances being alike, there would be a progres- 
sive increase in the severity of the symptoms as we approximate to- 
wards the sultry climate of the equatorial latitudes; and that local 
causes, which, as far north as New York, would merely give rise to 
regular tertians, in Georgia and Alabama would produce the higher 
grades of the bilious remittent. This influence of change of climate 
in mitigating or aggravating the character of endemic fever, corres- 
ponds with the progress of the season in changing the type of local 
epidemics. 

But as it is not my intention on the present occasion to enter into 
the investigation of the various causes of epidemical diseases, having 
endeavoured to establish the remote influence of heat in the produc- 
tion, under favourable circumstances, of the endemic fever of warm 
and intertropical climates, I will advert to the inquiry concerning its 
agency in giving rise to hepatic affections. 

Few, I presume, will question the truth of the position, that bile 
is secreted much more abundantly in hot and unhealthy than in cold 
and salubrious climates. This is confirmed by the almost unanimous 
testimony of those whose experience entitles them to credit and re- 
spect, who have written on the diseases of hot countries. Such be- 
ing the fact, are we not authorized in the presumption that there 
must be a necessary connexion, similarity, or identity of the causes 
of this increased biliary secretion and the concomitant diseases of the 
climate? And from the knowledge which we have of the influence 
of heat and moisture in occasioning the extrication of miasmata, and 
thereby giving rise to intertropical diseases, are we not warranted in 
affirming that these miasmata are essentially connected in the increas- 
ed and morbid secretion of bile, so remarkable in unhealthy seasons 
and situations? It was previously stated that one way in which fe- 
ver operated in the production of visceral disorders, was by causing 
the indirect debility of the cold stage, and thence, from occasioning 



98 Heustis on the Liver and Spleen* 

spasm, debility, or contraction of the extreme portions of the circu- 
latory system, producing congestion in the liver, spleen, and other 
viscera of the body. But as in the cold stage of fever all the secre- 
tions of the body are in a great degree suspended, although the liver 
is overloaded and gorged M^th blood, still, as its secretory action is 
diminished, we of course cannot suppose that any increased secretion 
of bile can take place in this stage of the disease. But are we not 
warranted in supposing that febriiic miasmata produce their delete- 
rious effects in consequence of the vitiation they occasion in the fluids 
of the body.^ And, as I have already attempted to show that the 
office of the liver is that of purifying the blood from the redundancy 
of excrementitious matters which it has acquired in the course of the 
circulation, we may readily suppose that any morbid vitiation of the 
circulatory fluids, such as takes place in the endemic fevers of hot 
and marshy countries, would impose an extra labour and burthen on 
the liver, and either overpower it by excess of stimulation, or excite 
its vessels into preternatural action, and thereby give rise to an in- 
creased and vitiated secretion of bile. I have already attempted to 
prove that heat alone, or even sudden vicissitudes of weather, are not 
sufficient to produce derangements of the biliary secretion. It is true 
that sudden alternations of cold and heat, may, in common with 
other parts, procure inflammation of the serous surfaces of the tho- 
rax and abdomen, as also of the mucous lining of the respiratory or- 
gans, and even of the parenchyma of the lungs; the same cause is 
also common to rheumatic and inflammatory aftections in general. 
But why, I would ask, is there in unhealthy climates and situations 
such an exception to the laws of ordinary causation, that the liver 
alone should so often be singled out as the seat of disease, in ge- 
neral exclusion to the other organs and portions of the system? How 
can this be explained or accounted for? I will leave it to the reader 
to determine whether the notions I have ventured to advance in re- 
lation to this subject are not more satisfactory than those which refer 
hepatic affections and increased secretion of bile to the supposed 
sympathy between the skin and the liver? 

■I might here give an account of the influence of solar heat in pro- 
ducing those sudden affections called sun stroke, coup de soliel, ictus 
solis, ceriasis, &c. as also of the more gradual and permanent influ- 
ence of hot climates in giving rise to the various symptoms of debility 
in the human system, and the constitutional derangements arising 
therefrom, but to treat these subjects in extenso would exceed the 
limits I have assigned to this article: a few remarks must therefore 
suffice. As heat is a stimulus, it is obvious that when intense and 



TdXMerro^s Case of Paralysis. 99 

long-continued it must contribute to exhaust and debilitate the sys- 
tem. When the body has been for some time enveloped in a high 
atmospheric temperature, the sensation of heat becomes disagreeable 
and distressing; the heart and arteries are excited into quicker and 
stronger action; the fluids of the cutaneous and pulmonary vessels are 
expanded, and thence a degree of expansion is communicated to the 
general mass of the circulating system; the animal heat is augmented, 
and to obviate any dangerous tendency arising therefrom, nature be- 
comes relieved by a flood of perspiration breaking out from the over- 
strained and relaxed exhalents of the surface. This calorical stimu- 
lation of the system at length induces a degree of exhaustion and 
debility, more general perhaps than that occasioned by corporeal la- " 
bour and exertion. Yet if the respirable medium which we breathe 
is free from deleterious and morbific'Contaminations, the refreshment 
and repose of sleep restores, in a great degree, the exhausted and re- 
laxed energies of the human frame, and winds it up for another day 
of toil and endurance. Sudden and intense heat, like over-exertion, 
deranges the functions of the digestive organs, owing to the sympathy 
of the stomach with the general system, and thence giving rise to im- 
paired digestion, from the more crude, watery, and less elaborated 
quality of the gastric fluid, resulting from the debilitated condition 
of the stomach, as produced by its sympathetic association. But the 
head is also frequently a severe sufterer from the like cause. The 
increased impetus of blood which takes place to that part, producing 
over-distention of the vessels, gives rise to head-ache, epistaxis, syn- 
cope, drowsiness, and convulsions. A general sensation of languor 
pervades the system, and there is a great disinclination to muscular 
exertion. The whole body is relaxed and debilitated, and the mind 
is enervated and listless. Such are a few of the most obvious effects 
of exposure to high atmospheric temperature. And it is scarcely ne- 
cessary to say how strong is its tendency to produce a state of pre- 
disposition to be acted upon hy any adventitious morbific agent which 
may be engendered and coexist at the same time. 



Art. VI. Case of Paralysis, successfully treated tvith Moxas. By 
W. T. Taliaferro, M. D. of Kentucky. 

h EW if any cases of paralysis cured by moxa, having ever been re- 
corded in the American journals, I am induced to draw up an ac- 
count of the following case, in which that remedy was resorted to 
with success. 



100 TdXizi&CTQ^s Case of Paralysis. 

The subject of this case is a lady, aged twenty-one years, who had 
been affected with paralysis for some time previous to my seeing her, 
and had been attended by Dr. Clapp, of New Albany, Indiana, who 
has favoured me with the following history of her symptoms whilst 
under his care. 

"Miss S. was attacked in the early part of April, 1827, with paralysis of 
both hands, which finally extended to her feet and legs. The palsy was pre- 
ceded by a numbness, loss of motion, and some pain of the index finger of the 
left hand. On inquiry, it appeared she had had considerable abdominal de- 
rangement for several weeks previous to the access of the paralytic symptoms, 
indicated by considerable irregularity of the bowels and symptoms of functional 
disorder of the liver. Supposing the disease sympathetic of abdominal disease, 
rather than from disorder of the brain, it was treated with mercurial purges and 
alteratives, occasional emetics, vesicatories, cupping, and ungt. tart, antim. 
The blisters and pustules from the ungt. tart, antim. were of no apparent be- 
nefit. The mercurials appeared to be of service, especially when her mouth was 
somewhat tender. Vomits were of decided benefit, and the cupping was bene- 
ficial, dry cupping almost as much so as when the skin was scarified. Some of 
the discharges from the bowels were black and glutinous — some worms were 
discharged. After the excitement was considerably reduced, the nux vomica 
was used with apparent advantage at first, but soon ceased to be of any bene- 
fit, though it was not carried any farther than to produce a slight trembling of 
the palsied parts. The sal quinine has lately been of service as a tonic. The 
tinct. sanguin. canadens. M. 9., tinct. opii. M. iij. M. terin die, seems to be be- 
neficial as an alterative and stimulant — it causes a pricking sensation in the pal- 
sied parts; in a larger dose it nauseates. Miss S. was my patient nine or ten 
weeks, and recovered so far as to enable her to return to Kentucky, her home. 
I regret much it is not in my power to give you a more particular history of 
this case." 

I was requested to see Miss S. in December, 1828, when her 
symptoms were as follows: — great debility; total inability to move 
the lower extremities, and very little or no use of the right arm, and 
entirely unable to raise her left, or close the hand; loss of appetite; 
weak, irregular pulse, varying from thirty -five to forty-eight in a minute; 
tongue thickly coated with a white fur; sickness at stomach; constant 
pain in the head; obstinate constipation of the bowels; catamenia regu- 
lar; paralysis of the bladder; extremities cold and much swollen. Be- 
lieving that the disease proceeded from gastric derangement and tor- 
por of the liver, I made an attack upon those viscera with the fol- 
lowing cathartics: — R. Podoph. peltat. 9ij.;Cal. ppt. etscammo. aa. 
5j. M. f. pilula No. xxxij. Ordered four for a dose to betaken at bed 
time — gruel, &c. next morning. The first five or six doses operated 
well, producing three or four consistent alvine evacuations, dark and 
fetid; debility increased; no feeling in the feet, or left index finder, 



TslidiiQTTO^s Case of Paralysis. 101 

in which she had had a paronychia, which had been incised one or 
two years prior to the paralytic attack. After a perseverance with 
the pills for eight weeks, without the smallest appearance of a change 
for the better, the pills were repeated every other night. I then gave 
the nitrate of silver in pills of half-grain doses and upwards, night 
and morning: — R. Argent, nitrat. et Medull. pan. aa. 5j. M. f. pi- 
lulse, No. cxx. — they operated briskly on the bowels for a few days, 
and increased the appetite, producing a burning sensation of the sto- 
mach, but finally ceased to have any good effect — no affection of the 
skin, though she had taken three hundred pills. I now began to des- 
pair of success, there being greater loss of power in moving the ex- 
tremities, with increased pain in, the small finger of the right hand. I 
determined, however, on trying the moxa, which is so highly recom- 
mended by Baron Larrey, in his Surgical Essays. As soon as I pro- 
cured the port-moxa, I requested my very intelligent young friend, 
S. M'Adow, M. D. to visit Miss S. and in his presence I applied 
the moxa to the index finger^ on the middle of the first and second 
joint, directly over the escar caused by the incision for the relief of 
the paronychia, and continued the application until the whole, (an 
inch,) was consumed, without the patient being sensible of the smal- 
lest pain. 

In an hour I applied a second between the fourth and fifth cervi- 
cal vertebra. Her complaint was now different — said it produced 
slight pain, at the same time an agreeable sensation, with a gentle 
glow through the system; pulse accelerated to 79. I directed one 
drop of the ol. croton tigl. at bed time, and to be repeated every 
third night. Diet light and nutritious. 

1829, Feb. 18th. Pain in the head; livid blisters over the feet; cold 
perspiration; costive bowels; pulse 63. Applied moxa to the neck 
and ankle; cathartic continued. Bilious, watery discharges. The oil 
produced some pain in the bowels, but operated speedily. 

Feb. Z9,d. Symptoms as above. Applied moxa to the neck and 
left ankle; acute pain in the former, none in the latter. 

^5th. Fever; pulse 98 and small; throbbing in the temporal arte- 
ries; bowels continue costive; tingling sensation in the feet; pain in 
the ankles and forefinger, where the moxa was first applied; feet con- 
tinues to perspire; no passage without medicine: great difficulty in 
urinating. Ordered four of the former pills at bed time, and a drop 
of the oil next morning; applied two moxas over the lumbar vertebra. 
March 1st. The cathartics produced several consistent and brown 
discharges; nights restless; pain in the head continues; cold feet; 
pulse 85 and small; three of the blisters from the moxa slightly sup- 
No. XL— May, 1830. 10 



102 Taliaferro's Case of Paralysis, 

purating from neglect in applying the aq. ammon. Applied moxa to 
the nape of the neck and middle of the left arm; ordered sem. sinip. 
half an ounce, bis in die. 

Qth. Evidently better; appears rather stronger; appetite improving; 
bowels more open; discharges more natural; pulse 90, full and regu- 
lar; urinates tolerably easy; lower extremities cold; cold clammy per- 
spiration on the feet; slight pain in the head. Applied moxa to the 
right shoulder, and one over the heart, where she complained of acute 
pain; burns kindly healing; continue the sem. sinip. 

19.th. Extremities cold; bowels regular. Applied moxas to the 
neck. Appetite improving; urinates freely and without pain. 

18M. Applied moxas, two on the upper part of the dorsum, on each 
side of the sixth and seventh vertebra. Sleep refreshing. 

24^A. Pulse 80; tongue clean; pain in the head and back, with some 
weakness in the latter, when raised in bed; unable to move the lower 
extremities, or even the toes. Applied two moxas. 

S0^/«. Pain in the back; difficulty in urinating since last visit; 
bowels costive; pulse 89. Applied moxa to the sacrum, two on each 
side of the spine. 

April 6th. Frequent syncope when raised to take drink; blisters 
on the feet much more numerous and livid; urinates easy; pain in the 
back lessened; desires the moxa more frequently, said they were 
really pleasant; tongue clean; slight pain in the head. Applied two 
moxas to the sacrum. 

14th. Restless nights, starting and dreaming; pulse 78, full and ir- 
regular; acute pain in the left elbow. Applied two moxas on each side 
of the humeral processes; great aversion to medicine of any kind, but 
willing to have the moxa applied daily. 

9,1st. Rests well at night, sleep refreshing; spirits improving; feels 
stronger; pain in the head lessened; tongue slightly furred. Applied 
moxa to the sacrum; ordered four pills; burns healing. 

9.9th. Sleep refreshing; pain and swelling in the arm lessened. 
Applied moxa to the sacrum. Pain in the back removed; urinates 
easy and copiously; cold extremities; tongue moist; appetite improv- 
ing; sat up to-day one hour in bed. 

May 7th. Pulse 85, quick and small; sat up to-day half an hour 
in an arm-chair; considerable improvement; natural feeling returning; 
complains of the moxa; slight pain in the temples; swelling in the 
feet subsiding, and blisters also disappearing; countenance cheerful; 
sanguine of a speedy recovery. Friction with the flesh-brush to the 
body and extremities. 

15th. Miss S. informed me to-day that she had had severe pain 



Taliaferro's Case of Paralysis. 103 

since my last visit, in the left knee, with numbness and pain in her 
feet^ acute pain in her left breast, directly under the mammae; head 
clear of pain; sat up all day for several days past; can stand alone; 
bowels open, and urinates with ease. Applied two moxas to the sa- 
crum. 

20^^. Her mother applied moxas over the great sciatic nerve, and 
it was with great difficulty that she bore it; almost clear of pain. 

9.5th. Pulse 76, full and regular; tongue clean; appetite good; 
bowels open; fond of beef steak; allowed any kind of diet. 

June 7th. Rode out to-day two miles; pulse 85; no pain in hip or 
knee; appetite good; sleep reviving. 

18//i. Continues to mend. Applied two moxas. 

28/A. Still improving; walks about the house up and down stairs 
without assistance. 

July 8th. Pulse 85; no pain; moxas almost insupportable, produces 
sweat and flushing of the face; bowels regular. 

16th. Spirits fine; gaining flesh; burning in the feet; blisters dis- 
appearing; sweat subsiding, and warmer. 

9,4th. Stronger to-day than for the last two years; pulse 80, full and 
soft, complexion red; bowels regular; tongue clean; slight pain in 
the left knee. Ordered two moxas; appetite fine, and sleep undis- 
turbed. 

SOth. Rides out daily; pain in the knee removed; clear of all pain 
in the head; feeling in the feet and hands nearly natural. 

July 1st. On a visit to Mayslick, distance ten miles; can walk 
some distance without fatigue. 

August 19th. Slight pain; requested Dr. Sharp to apply the moxa, 
for fear of a recurrence of palsy, which she bore with great difficulty. 

Oct. 9th. Very much improved. Her mother informed me to-day 
that her bowels ^re regular, that she urinates with perfect ease, and 
is in better health than she ever was in her life. 

Jan. 91st, 1830. At this time she is in the enjoyment of good 
health, weighing forty or fifty pounds more than she did, January, 
last. No symptoms of numbness or pain. Miss S. resides seven miles 
from this place. 

I have used the moxa successfully within the last fourteen months, 
in two other cases of paralysis, both men, one aged seventy-six, the 
other thirty -four. 

Washington, Mason County, Ky. Jan. 25, 1830. 



104 Jackson on the Pulse and its Modifications. 

Art. VII. Of the Pulse and its Modifications. By S. Jackson, M. D. 
Assistant to the Professor of the Institutes and Practice of Me- 
dicine and Clinical Practice in the University of Pennsylvania. 

X HE pulse has engaged the attention of medical practitioners from 
the earliest periods of the science, and has deservedly been regarded 
as furnishing, in the exploration of the human system, the most im- 
portant symptoms to determine its healthy or pathological condition. 
The study of the pulse created the sphygmic artj but in the absence 
of a correct theory of the pulse, that might have restrained the illu- 
sions of fancy, a large proportion of what has been written on this 
subject, is to be set down to exaggerated pretensions, empirical va- 
nity, and fallacious experience. 

A theory of the pulse must of necessity be engrafted on, and be 
modelled after, the theory of the circulation, of which it is a phenome- 
non. Before the discovery of the circulation, the nature of the pulse 
was unknown, and ignorance in this respect led to the adoption of 
many erroneous notions. A great number of pulses were supposed to 
exist, and every morbid affection to be infallibly indicated by them. 
At this day, equal extravagances prevail amongst the Chinese, who 
possess a doctrine of tlie pulse which is artificial and complicated in 
proportion to their ignorance of the circulation, and the real nature 
of the arterial pulsations. The history of the pulse, strikingly illus- 
trates the remark, that without a sound theory, observation and ex- 
perience most commonly confirm errors, and establish delusions. 

The discovery of the circulation, by imparting correct opinions of 
the character of the pulse, overthrew the system which had been 
erected on bare hypothesis. Though the idle pretensions that had 
been claimed for the indicative character of the pulse, were very con- 
siderably reduced, still, the immaturity of knowledge in that respect, 
gave rise to other notions, not less devoid of accuracy. The new 
principles of indication founded on the pulse, were rather a change 
of errors than a discovery of the truth. 

The present doctrine of the circulation, which makes it to consist 
of two distinct orders or kinds, executed by different structures, and 
moved by different forces, produces an entire modification of the 
doctrine of the pulse, and enables us to give a positive explanation to 
the various phenomena it manifests, and to estimate their real value 
as diagnostic and prognostic signs. 

The view of the circulation we adopt is its division into, 1st, a 
vascular or direct^ and 2d, a capillary and parenchymatous or inter- 



Jackson on the Pulse and its Modifications. 105 

©titial circulation. To the first, belong the heart, arteries, and veins; 
to the second, the reticulated, interstitial, and parenchymatous tex- 
ture of the organs. This last is constantly permeated by a certain 
quantity of fluids, in definite proportions for each species of tissue, 
which belongs to the tissue as a part of its organization, and hence 
may be termed organic fadd or humour. All the phenomena of life 
are the result of the mutual action of the molecules of this fluid, and 
the molecules of the solid or organic structure on each other. Con- 
stantly undergoing mutations, it requires an incessant renewal, and 
for the purpose of its renovation is the vascular circulation provided. 

The capillary system thus derives its supply of arterialized, or 
oxygenated, or proper nutritive humour, from the vascular system; it 
returns back into the vascular system the molecules unfitted for the 
actions of vitality. 

The vascular system is a system solely of supply to the capilla- 
ries. Its moving power is the heart. It communicates with the capil- 
laries, placing at their disposition oxygenized or arterial blood, which 
they attract into themselves in each organ, according to the immedi- 
ate wants of the organ, and the activity of its actions or excitement. 
The two orders of vessels, arteries and veins, composing the vascular 
system, have a two-fold communication with each other; a direct 
communication, the artery changing into a vein, and an indirect, 
through the capillary system. 

The force moving the capillary circulation, resides in the capilla- 
ries, and belongs to the organized structure. Its nature is not yet sa- 
tisfactorily developed, but many facts appear to indicate it to be an 
electro-galvanic power directed by the agency of the nervous system. 

Of the vascular circulation, the pulse is an absolute indicator, 
pointing out its condition in a positive and direct manner. It does 
not respond as immediately to the various states of the capillary cir- 
culation; but as this last exercises a controlling influence over the 
vascular circulation, aided by induction and a comparison with other 
symptoms, the pulse indirectly exposes the condition of the capillary 
and areolar circulation. 

The pulse is caused by the shock communicated to the whole mass 
or column of blood contained in elastic vessels, (the arteries,) by the 
contraction of the ventricles. The vessels opening into the ventri- 
cles, and the blood being a continuous mass, in a natural state, com- 
pletely occupying the cavities of the heart, vessels, capillaries, and 
parenchyma or areolar texture of the organs — when the ventricles 
contract, the blood they contain is forced into the arteries, and the 
sanguine column included in these vessels, receives a simultaneous 

10* 



106 Jackson on the Pulse and its Modifications. 

impulse in every portion. The pulse is not, consequently, produced, 
as was long supposed, and is still conjectured to be, by a succession 
of waves following each other through the vessels. It is every where 
synchronous, and the diastole of the arteries corresponds with the 
systole of the heart. Spallanzani, in examining the action of the 
vessels, expressly remarked, in several of his experiments, that the 
pulsation in the aorta, the mesenteric artery, and its smallest ramifi- 
cations, was instantaneous. " The aorta," he observes, " when the 
heart contracted, swelled up at once from its origin to its termina- 
tion." And although from his notion of the circulation he supposed 
''the pulsations must occur in succession," yet he acknowledges as 
the result of his numerous experiments, "that at the very moment 
the heart contracts, the aorta and the whole of the arterial system 
seem to beat at one and the same time." 

It has been a subject of dispute whether the arteries experienced a 
dilatation in consequence of the impulse communicated to the blood 
by the contraction of the ventricles. A very slight dilatation cer- 
tainly does occur, though much less than was formerly supposed, or 
might be believed, from observing superficially the pulse. This point 
appears to be very accurately settled by the experiments of Spal- 
lanzani, Parry, and Poiseuille. 

Three circumstances govern the pulse, of which it furnishes the 
indications: 1st, the frequency or slowness, force and rythm, or or- 
der of the ventricular contractions; 2d, thequantumof blood actually 
contained in the vessels or proper vascular system, which is govern- 
ed by the state of the capillary and areolar circulation; and 3d, the 
state of the arteries. 

1st. The pulse depending so much on the action of the heart, par- 
takes of all its aberrations from the natural state, and these devia- 
tions are the consequence of idiopathic affections of the heart, or of 
its sympathetic disorders. The last are the most common, for the dis- 
eases of acute, and most of those of chronic irritations, extend their 
influence to the heart, and involve it in the morbid condition. 

The modifications of the pulse arising from the contraction of the 
heart, are those affecting its frequency, slowness, force, and rythm 
or mode of pulsation. ' 

Frequency of the pulse is the most constant and certain symptom 
of an existing irritation in the organs. Whenever the heart experi- 
ences irritation, either sympathetically or primitively, its contrac- 
tions are quickened, and so long as a frequent pulse continues, what- 
ever may be the improvement of other symptoms, we should always 
suspect a lurking inflammation, and endeavour to exterminate it. 



Jackson on the Pulse and its Modifications. 107 

The diminution of the frequency of the pulse, in acute diseases, is 
uniformly a favourable sign, while its persistance is as positive an 
evidence nearly of the continuance of the disease. In convalescence 
from gastro-enteritic fevers, after the perfect reinstatement of the 
alimentary organs in their healthy state, I have frequently found the 
frequency and irritation of the pulse continue, and every attempt to 
increase the diet or invigorate the patient by tonics, to be attended 
with febrile excitement. The irritation of the heart in these cases, at 
first merely sympathetic, had become established permanently, and 
did not terminate with the cessation of the primary irritation. It is 
to be overcome by local depletion from the cardiac region, blisters to 
the same part, small bleedings, and restricted regimen. If neglected, 
organic disease of the heart will sometimes succeed, or the patient 
be cut off* by dropsical effusions. 

Frequency of the pulse may be combined with its force and ful- 
ness, but they do not necessarily accompany each other. 

The contractions of the heart, in the majority of persons, average 
from sixty-five to seventy in the minute; above that number, the pulse 
is said to be frequent. It often mounts as high as one hundred, one 
hundred and twenty, and seldom beyond one hundred and fifty in 
the minute. 

When the contractions of the heart are very feeble, from the emp- 
tiness of the vascular system, they increase in frequency, as though 
the deficiency in the quantity of the blood circulating, was to be com- 
pensated by the increased velocity of the circulation. It is scarcely 
possible to mistake the frequency of the pulse from this cause, for the 
frequency produced by irritation. It is always attended with extreme 
weakness of the pulse. 

Quickness of pulse differs from frequency; it has reference to the 
time of each pulsation, and depends on the systole of the heart being 
performed with a rapid contraction. Most commonly it accompanies 
frequency of the pulse, and is an evidence of existing irritations. The 
frequent pulse of exhaustion is generally a quick pulse. 

Slowness of pulse is usually employed as opposed to its^frequency, 
and expresses the fewer number of pulsations than is usual in a given 
time. Rareness or paucity of pulse would be a more correct designa- 
tion, to distinguish it from slowness, as contrasted with quickness. 
The diminution in the pulsations of the heart, manifests the absence 
of irritation in that organ, or its declension, if they had been previ- 
ously frequent. Rareness or paucity of pulse accompanies at times a 
full and strong pulse, particularly in the congestions of the cerebral 
organs, and is also an attendant on a small and feeble pulse, especi- 



108 Jackson on the Pulse and its Modifications. 

ally in chronic diseases, attended with serous effusions. It is pro- 
duced bj digitalis, and appears to be a specific action of that remedy, 
diminishing the irritability of the heart, and consequently the num- 
ber of its contractions. 

Slowness of pulse, as opposed to its quickness, has relation to each 
pulsation. It arises from the same causes as rareness of the pulse, a 
state of ab-irritation or asthenia of the heart or mobile organ of the 
circulation, and sometimes of the softening of its parietes. 

A strong or forcible pulse proceeds from the energy of the ventri- 
cular contractions. Most commonly it belongs to a fulness of the 
vascular system, or plethora, and manifests excitement and vigour in 
the heart. It attends on hypertrophy of the left ventricle. 

A feeble pulse marks, in most instances, a low state of excitement 
in the heart, and indicates exhaustion of the vascular system. It may 
be accompanied with slowness or frequency. In carditis and pericar- 
ditis the pulse is said to be feeble, which then proceeds from the dis- 
ability of the ventricles to contract, like other muscles, when they or 
their sheathes are in a state of acute inflammation. 

The last modification of the pulse emanating from the heart, relates 
to its rythm, or mode of action. In this respect, the pulse maybe equal 
or regular, unequal or irregular, and intermittent. In a regular or 
equal pulse, all the pulsations are similar; a pulse is unequal or irre- 
gular, when the pulsations do not correspond to each other in fre- 
quency, quickness, and force; a pulse is intermittent, when, after 
several pulsations, there occurs a momentary repose. These condi- 
tions of the pulse proceed from different modes of contraction of the 
ventricles. The irregular and intermittent pulses belong to organic 
diseases of the heart, and occur also in acute diseases, from sympa- 
thetic disturbances in that organ, which, I am disposed to believe, are 
only excited by irritations of the digestive organs. At least, I do not 
recal pulses of that character in the diseases of other organs, except 
of the heart itself. The irregular is a more unfavourable than the in- 
termittent pulse. I have known instances in which an intermittent 
pulse was natural to the individual; it continued for years, and dur- 
ing the enjoyment of good health. 

2d. The capillary system modifies the pulse, as to fulness or emp- 
tiness, by determining the quantity of blood contained in the vas- 
cular system, and regulates, in these respects, the state of the di- 
rect circulation. This last supplies the capillary system, which at- 
tracts from the arterial and withholds from the venous vessels the 
proportion of blood it requires, determined always by the state of its 
excitation — the vascular or direct circulation is governed, as to reple- 



Jackson on the Pulse and its Modifications. 109 

tion or vacuity, by the state of the capillary circulation in the differ- 
ent organs. Fullness or emptiness of pulse are, then, indications of 
the condition of the capillary circulation. These states of the pulse 
are produced, however, under particular circumstances, and in a man- 
ner requiring to be noticed. 

When a limited extent of the capillary system is engorged with 
blood, as occurs in irritation and inflammation, the circulation of 
the congested part, is sluggish or suspended, and the portion thus af- 
fected, ceases to admit further supplies for the time, from the artery 
conveying the sanguine humour to it. The amount of blood which 
previously passed into the capillaries, is now accumulated in the 
artery, and passes into the veins exclusively by the direct communi- 
cation, existing between those vessels. They are consequently replete 
with blood — the artery, completely distended, is full and hard, and it 
more perceptibly manifests the momentum of the heart's contractions* 
This I regard as the correct explanation of the full, strong pulse, felt 
in the arteries supplying an inflamed part, as in the radial artery, in 
very acute inflammation of the hand. 

Inflammation of the brain or meninges with light congestion, pro- 
duces the same effect in the carotid arteries; and to a greater extent, 
the same circumstance is observed in the extreme congestions of the 
brain, as in apoplexy. In these last cases, the pulse of the whole vascu- 
lar system, is full, strong, and often slow. The degree and extent of 
thfe congestion, which occupies the external as well as internal capil- 
laries of the head, arrests the capillary movements, and of course the 
demand of these organs receiving in a natural state, as is estimated, an 
eighth of the whole circulating fluid, while the general torpor of the 
capillary system throughout the economy, which attends on this dis- 
ease, diminishes, in some degree, the call made on the circulating fluid. 
The vascular system, in consequence, acquires a repletion of blood, 
the vessels are distended, the pulse full and strong, and as no irrita- 
tion exists in the heart, its contractions are slow. 

Precisely the reverse is the effect on the general or vascular circu- 
lation and pulse, of irritation in the extensive membranous tissues 
rich in capillaries, and in capacious organs of highly vascular struc- 
ture, producing in them profound congestions. The quantity of blood 
these organs and tissues are capable of containing, and which, under 
the influence of irritation they abstact and withhold from the vascu- 
lar system, is so great as to reduce the general circulation to a 
state of extreme exhaustion, A small deficient current flows through 
the arteries and returns immediately by the veins. The heart in a 
^tate of asthenia, contracts with feebleness on its half-distended ca- 



110 Jackson on the Pulse and its Modifications. 

vities, and the pulse is scarcely to be perceived, and sometimes is en- 
tirely absent, when the volume of blood is not adequate to bring the 
elasticity of the arterial coats into action. 

In the commencement of irritations of the internal viscera, espe- 
cially of the digestive or alimentary organs, before reaction, or the 
irradiation of the irritation into other organs has ensued, the capillary 
and areolar circulation of the external surfaces is diminished, the ca- 
pillary circulation concentres towards the seat of irritation, where 
the blood accumulates and is detained until it is dispersed by the es- 
tablishment of reaction. This concentration of the circulating or nu- 
tritive humour in a portion of the capillary system, forms the cold 
stage of fevers, and is the essential condition of visceral congestions, 
which have formed so prominent a feature of late in some systems, 
though their mode of production was not understood. Its direct ef- 
fect is to abstract blood from the vascular system, equivalent to a 
depletion, and the quantity of blood of which the vessels are depriv- 
ed, is proportioned to the intensity and extent of the concentric 
movements of the capillary circulation, and degree of congestion in- 
ducedj it is often equal to the abstraction of many pounds of blood. 
Hence arises, in this state, the weak, feeble pulse, a sign of debility 
in the contractions of the heart, and emptiness of the vessels. 

The same result, as to the vascular circulation and pulse, is pro- 
duced by extensive irritations of the cutaneous surface, determining 
sanguine congestion of its capillaries. This state exists in the erifp- 
tive fevers, or exanthematae, when of a high grade, and which are then 
attended with a weak, empty pulse. Scarlatina, when of intense cha- 
racter, as in its malignant form, is a remarkable illustration of the 
fact. The disease, in this state, exhibits the skin from the head to 
the feet of a deep red, demonstrating the actual presence of red blood 
in the skin, in a quantity entirely unnatural. The internal mucous 
tissues, in this malignant form of the disease, is shown by dissection 
to be in the same condition. Here then is presented the occular de- 
monstration of the permanent congestion of the cutaneous capillaries, 
the detention of a large quantity of the circulating fluid in them, and its 
consequent deprivation from the vascular system. Now, in this form 
or stage of scarlatina, the pulse is always deficient in fulness and 
force, and in the highest grades of the disease, the pulse is reduced 
to such extreme exility, it is scarcely distinguishable. 

This feeble, empty pulse of scarlatina maligna, has been supposed 
to be the consequence of extreme debility of the vital powers, and to 
require the sustaining energy of stimulants and tonics. I have nevei' 
witnessed from their employment, more, even w^hen lavishly adrai- 



Jackson on the Pulse and its Modifications. Ill 

nistered, than a transient effect on the circulation, and by augment- 
ing the morbid irritation of the cutaneous and mucous surfaces, and 
thereby confirming their congested state, they have increased the 
vascular exhaustion, and have enfeebled to a greater degree, the ac- 
tion of the heart and pulse. Cold or tepid evaporating ablutions, 
used according to circumstances, by diminishing the cutaneous irri- 
tation, relax the capillary congestion, the blood resumes its natural 
course into the vascular system, which fills up and expands, and the 
pulse acquires fulness and firmness. I have seen, in scarlatina, the 
pulse, as ablutions were employed or discontinued, become alter- 
nately full and firm, or empty and feeble. In rubeola or measles, when 
malignant, and in confluent small-pox, the exhaustion of the vascular 
system, and extremely small and feeble pulse, are produced in this 
same manner. 

This principle, which I consider as of the highest importance in a 
practical view, when fully appreciated, has a very extensive applica- 
tion! and it places in a very clear light, the important fact, that a pa- 
tient, in irritations of great activity, is threatened at the same instant 
with impending dissolution, from opposite conditions of his organs — 
that is, from extreme feebleness and exhaustion of the vascular cir- 
culation, and violent congestive irritation in the capillaries of the ce- 
rebral, pulmonary, or abdominal viscera, suspending their func- 
tions. It exhibits also the necessity, under those circumstances, of 
resorting, at the same instant, to a compound and opposing treatment, 
explains the objects to be attained by it, and the manner in which it 
is to be directed. 

3d. The arteries modify the pulse, when they are themselves in a 
pathological state, to which they are subject, as well as the other or- 
gans of the economy. Acute inflammation, as in arteritis, causes 
firmness in their coats, and the pulse is then hard. The inception of 
ossification renders the pulse obscure, and when it is complete, the 
artery losing its elasticity no longer responds to the shock communi- 
cated by the heart, and the pulse is lost. The coats of the arteries, 
in some instances, are softened from a species of infiltration of fluid 
into their interstices, which lessens their elasticity and impairs their 
pov/er of reaction. 

The calibre of the artery has an influence over the pulse. I have 
seen, in a case of dilatation of the heart, all the arteries preternatu- 
rally small, and which produced a remarkably small pulse. Undue 
enlargement of the arteries is not uncommon. The pulse, in a nor- 
mal state of the circulation, is then large and full, and under excite- 
ment, is exceedingly deceptive. It appears to indicate profuse and 



112 Jackson on the Pulse and its Modifications. 

repeated bleedings, but fails with rapidity under sanguine depletion, 
assuming a peculiar yielding and flaccid sensation, as though the ves- 
sel contained a gaseous or exceedingly tenuous fluid. 

The pulse in many individuals is very feeble; it is scarcely discerni- 
ble. They enjoy, notwithstanding, excellent health. The energy of 
life does not depend on the force and velocity of the vascular or di- 
rect circulation, but on the activity of the capillary circulation. Per- 
sons who are prone to obesity, have usually a small and feeble pulse. 
It is a common explanation of the fact, to attribute it to compression 
on the arteries from the accumulation of adipose matter. This is not 
correct; the arteries and whole vascular system in such persons, is not 
developed to the same extent as in others, and the vascular circula- 
tion is more inactive. 

The pulse is in some instances entirely absent, without interfering 
with health. This circumstance occurred in the mother of Dr. S. of 
this city. The pulse disappeared during an attack of acute rheumatism, 
which did not appear to retard her recovery, and it never returned during 
her subsequent life. She was active in mind and body, and possessed 
unusual health. In no part of the body could a pulse be detected. I 
attended her during a part of the time of her last illness, which was an 
acute inflammation of the intestines, but no pulse existed. She died 
while I was absent from the city, and an examination was not made to 
elucidate the cause of this remarkable phenomenon. 

A great variety of pulses have been described by writers, who have 
drawn between them fine lines of discrimination, and attempted to 
establish a particular pulse for every disease, and for every critical 
symptom, the occurrence of which, it was believed, could be pre- 
dicted with certainty, or whose existence could be announced merely 
by the pulse. By the late Professor Rush, the pulse was regarded as 
a perfect nosometer, measuring with nearly absolute precision the 
state of the M^hole economy, and the grade and character of every 
morbid condition. 

These exaggerated views of the importance of the pulse, originated 
befoi'e the circulation was discovered, and the production and nature 
of the pulse was known. They were subsequently maintained by er- 
roneous opinions of the character of the circulation, its active forces, 
and the structure and oflice of the vessels. The direct circulation 
alone was understood, the capillary, and interstitial or parenchyma- 
tous were not comprehended, and the heart and large arteries were 
believed to be the sole causes of the circulatory phenomena. But if 
the doctrine of the circulation we have advocated, founded on the 
analysis of the organs and mechanism of this function, be adopted as 



Jackson on the Pulse and its Modifications. 113 

correct, it must be clear, that the pretensions claimed for the pulse, 
as a universal diagnostic standard, must be considerably reduced. 
As a positive indicator, it characterizes only the action of the heart, 
and the degree of repletion of the vessels. The state of the capillary 
circulation, and consequently of the organs of the economy gene- 
rally, is not manifested directly by the pulse, which in the determi- 
nation of this point, is of secondary importance. For this purpose it 
is to be taken in connexion with the symptoms exhibited in the dis- 
turbances of other functions, and compared with them. The heart sym- 
pathizing in most cases in the morbid affections of all the important or- 
gans, and the circulating fluid being influenced in its distribution by dis- 
eases of intensity, the pulse serves to give the value of the other symp- 
toms, and to render their nature manifest; and it thus furnishes se- 
condarily and by comparison, signs indicative of the condition of the 
capillary circulation, and the character of the pathological state of 
other organs than the heart. 

From this examination, it then results, that the pulse is not a ge- 
neral nosometer, but, as a standard of disease, is principally confin- 
ed to the aftections, either primitive or sympathetic, of the heart, 
and of the direct circulation. When, as frequently occurs, the heart 
and the direct circulation, from a paralyzed or quiescent state of the 
sympathies, do not participate in the morbid disturbances of the or- 
gans, the pulse fails entirely in presenting any positive indications of 
the state of those organs or the nature of the aff'ection. 

The forces regulating the direct and the capillary circulation be- 
ing distinct, and the offices of the two being totally different, they 
are often placed in a state of antagonism, and exhibit phenomena of 
opposing characters. The pulse in these circumstances, while it faith- 
fully marks the precise condition of the heart's action, and the state 
of the circulation, would betray us into fatal errors, if it were con- 
sulted in order to determine the condition of other organs. In the 
congestions of the abdominal and thoracic viscera, the functions of 
those organs are oppressed with a load of blood, while the heart is 
barely kept in action from the extreme deficiency of that humour in 
the vascular system. In the close also of diseases of acute inflamma- 
tions, widely diffused throughout the economy, important organs are 
pressing on to disorganization, demanding local depletion, and other 
sedative measures, with revulsive operations, while the action of the 
heart is fainting from debility, and requiring to be sustained by dif- 
fusible stimulation. These opposite indications cannot be revealed 
by the pulse. They are to be determined by other signs, and a reli- 

No. XI .—May, 1830. 11 



1 14 Jackson on Hematosis, 

ance on the pulse, in the manner that has been taught by high autho- 
rities, as a guide in estimating the condition of the economy, and in 
directing remedial measures, will lead to wrong conclusions, and a 
practice often fraught with mischief. 



Art. VIII. Observations on Hematosis^ with two Cases in which this 
Function was imperfectly performed. By Samuel Jackson, M. D. 
Assistant to the Professor of the Institutes and Practice of Medi- 
cine and Clinical Practice in the University of Pennsylvania. 

r ROM the complicate structure, diversity of organs and functions, 
the number of elementary principles, and differences of active forces, 
existing in and composing the animal organism, any exclusive doc- 
trine in explanation of its diseases must of necessity be replete with 
errors. Hence exclusive humoralism was necessarily wrong, as it ne- 
glected the solids, by which most of the vital phenomena are made 
manifest. Exclusive solidism is no less false, as it overlooks the 
fluids or humours which are organic, and are as essential to vital ac- 
tions and phenomena as are the solids. While partial and exclusive 
views thus regulated the principles of medicine, the science was in a 
state of constant vacillation between the two systems mentioned 
above. Neither being true exclusively, and both containing many 
truths, neither could satisfy all minds, yet each could enlist strenuous 
advocates, equally convinced of the correctness of those principles they 
did espouse. 

There is this difference, however, between the ancient doctrine of 
humoralism, and the modern. In the first was admitted many sup- 
posititious humours, and qualities were appropriated to them entirely 
hypothetical. In the modern doctrine, the humours are analyzed, 
and the part each plays in the organism is examined with rigorous 
induction. There is no other analogy betvv'een the two than the bare 
name. 

The most important of the humours is the oxygenated, arterialized, 
or sanguine nutritive humour. Though apparently homogeneous, it 
consists of difterent principles, which vary in their proportions in 
different individuals, and in the same individual, at different periods 
and under different circumstances. Concerned in every vital pheno- 
menon, the states or condition of this fluid exercise a most decided 



Jackson on ^ema/om. 115 

and profound influence over the organic and functional actions of the 
organs; modify the nutrition, and consequently the state of the so- 
lids; impress a peculiarity on the individual; and diversify the actions 
of morbific causes, the symptoms of the diseases they develope, and 
the operation of remedial means. 

The principal proximate elements of this humour, are water, albu- 
men, which dissolved in water constitutes serum, fibrin or globules, 
hematosine or colouring matter, a number of saline principles, and 
some of the principles of the different secretions. It contains, be- 
sides, many accidental matters, introduced into it in various man- 
ners. Now, the varying proportions of the above essential principles 
of the blood, will produce the modifying effects in the organism and 
its functions precedingly indicated. 

A moment's reflection on the part performed by this humour in the 
actions of the economy, and its liability to variation in its component 
principles from the qualities of the food, of the atmosphere, of habits 
of life, the state of the digestive and secretory actions, must produce 
a deep conviction of its importance in every pathological action. It 
is a matter of lively surprise, not only that this element of the pa- 
thological condition receives from physicians generally an entire ne- 
glect, but that any could be found to question its concurrence in the 
production of disease and modification of symptoms. 

The secreted humours appear at this time to attract the entire at- 
tention of a large body of practitioners, whose sole object is to ex- 
pel them from the bowels, and, like Furgon, nettoyer les corps et en 
evacuer entierement les mauvaises humeurs. The whole practice of 
physic may be comprised, according to this system, in the universal 
prescription, with one alteration, of Argan, in the laughable satire of 
Moliere on the profession: — 

Calomelas donare, 
Postea seignarSy 
\ Ensuita purgare, 

Meseignare, repurgare, et reealomesare. 

Of infinitely more importance is it to appreciate and determine the 
€tate of the mucous surface of the primse vise and appendant organs, 
the immediate cause of the secretions, than to occupy the attention 
with the secretions themselves. These are much more harmless than 
is supposed. Nature finds but little difficulty in getting rid of them. 
The product of a certain condition of the secreting surface, they bear 
most generally a relation to that condition, whether it be natural or 
pathological, and when the two are in the same relationship, the se- 
cretions, however morbid, cannot react injuriously on the organs. 



116 Jackson on Hetnatosis. 

But far otherwise is the case with the means employed to expel these 
morbid secretions. They are seldom in relation with the surface on 
which they act. Their action too is not in antagonism with the patho- 
logical state, but is of the same order — and it is not possible before- 
hand to pronounce positively that the therapeutic malady will sup- 
plant the pathological; that it will not act in the same line of march 
with the diseased action, and thus press it on in its destructive ten- 
dency. There are other means of equal potency, and of perfect 
safety, in changing the actions of the solids or organs, and thus ef- 
fectually restoring the secretions to a healthy order. These for their 
simplicity, are despised by the Purgons of medicine, who, ignorant 
of their mode of operation and of action, cannot conceive, that means 
which do not convulse the organs by their perturbating powers, can 
operate a salutary influence. This notion is of equal accuracy with 
that, which would attribute to nature no other remedy for the impu- 
rities of the atmosphere than a tornado or hurricane. 

It is not, however, the actions of the solids or organs alone, im- 
portant though this consideration certainly may be, that should fix 
the regards of the practitioner. Every element of the pathological ac- 
tion should be embraced in the extended scope with which he sur- 
veys its various conditions. Of these, the state of the sanguine nutri- 
tive organic fluid or humour, holds a primary rank, and for the ac* 
curate determination of every pathological problem, its distribution 
amongst the organs, the proportions, of its proximate elements, and the 
accidental qualities it may have acquired, should be subjects of in- 
vestigation, and as far as our knowledge will admit, be positively as- 
certained. 

It is not the object of this paper to enter into an elaborate exposi- 
tion of the doctrine of humoralism, founded on the nature of the or- 
ganic fluids, and their offices in the economy, or to vindicate its ap- 
plication to the pathology of morbid actions. My design is simply to 
indicate a condition of the nutritive sanguine humour of frequent ex- 
istence, as annually, cases of it fall under my observation, which 
presents peculiar characters, gives origin to certain symptoms, and 
which modifies those belonging to different diseases, in a manner 
to lead to most serious errors as to their nature. 

A deficiency or excess of blood, it is well known, may exist, con- 
stituting anemia, and hyperemia or plethora, and be productive each 
of peculiar phenomena. But a deficiency or excess of some one of the 
different elements of the blood may also prevail, and be the cause of 
particular states of the economy, or generate special symptoms, 
amounting to a pathological condition. In the highly marked lympha- 



Jackson on Hematosis. 117 

tic temperament, the watery and albuminous principles predominate 
over the fibrinous or globular and colouring elements, and modify in 
consequence the phenomena of disease. The highly sanguine tem- 
perament presents the opposite extreme, and fibrin or globules, and 
the colouring principles are in excess, equally impressing a peculia- 
rity on morbid phenomena. The circumstance, however, to which I 
now wish to attract attention, is the sudden diminution-, amounting 
almost to a disappearance of th« hematosine or colouring principle of 
the blood. 

The nutritive sanguine humour is formed from the nutritive prin- 
ciples furnished by the aliment, which are concocted into blood by 
the various processes through which they pass. In what manner he- 
matosine or the colouring principle is formed, what organ is charged 
with its production, or what is the process creating it, we have no 
knowledge. Respiration appears to have some agency in its forma- 
tion, yet this function may rather be presumed to perfect the process 
of its production, than to form it exclusively — for in the instances in 
which this principle was deficient, which have met my observation, 
respiration was wholly unimpaired. 

The following cases are selected from a number that have been pre- 
sented to me in the course of practice, as exhibiting the phenomena 
characteristic of the affection in a very striking manner. 

Case 1st. — Miss M*C , aged nineteen, lymphatic tempera- 
ment, hair of light brown, eyes a light gray, complexion fair, full 
embonpoint, skin soft and of delicate texture, limbs round and 
smooth, chest expanded. She has enjoyed uniformly good health — 
menstrual function commenced without difficulty, and has continued 
until the present period, uninterruptedly, though always very slight. 
She is attached to a choir of one of the chapels in the city, and hav- 
ing a very good voice, exercises it frequently in singing. 

In November, 1829^ she exerted herself, on an emergency, more 
than usual, though always active and very industrious, in finishing 
some dresses. Her zeal led her to take but little rest for three suc- 
cessive nights. In her employment, she uses a press, which requires 
considerable effort, and was, in consequence, very much overcome 
with fatigue. 

From this period she began to notice that slight exercise produced 
unusual lassitude and fatigue, excited palpitations of the heart, a throb- 
bing, obvious to the eye, above the sternum, and on the right side of the 
neck, and caused a sense of beating in the head, and through the limbs 
to the ends of her fingers. These symptoms continued to increase, 

11* 



118 ^d^okson on Hematosis. 

and the pulsation above the sternum and on the side of the neck, be- 
came permanent, although feeble when she was sitting. The aug- 
mentation of the symptoms finally arrived to such a degree as to pre- 
vent all active exertion, and in the commencement of January last, I 
was requested to take charge of her case. 

I visited her on January 4th, 1830. As she had been perfectly 
quiet, nothing could be observed but a sallowness of complexion, and 
a slight throbbing above the sternum and right clavicle. I explored 
the chest with the stethoscope. The respiration was clear and dis- 
tinct in every region of the thorax; indicating, as might have been 
expected, from her finely expanded chest, an admirable pair of lungs. 
The rithym of the heart was natural — the impulse rather strong, and 
sound somewhat louder than usual, but not to an extent that could be 
regarded as morbid, or belonging to organic change. No purring 
sound, throbbing, or uncommon noise under the right clavicle or su- 
perior end of the sternum, marks of aneurism, could be heard. The 
appetite was excellent; diet too full, meat being taken at every meal; 
digestion perfect, no kind of uneasiness or oppression being experi- 
enced after eating; bowels perfectly regular and evacuations natu- 
ral. The menstrual discharge which had declined rapidly since the 
invasion of the present symptoms, had not returned at the last pe- 
riod, the first of the month. The tongue was clean and moist, but 
was without colour, as were the lips, gurus, and inside of the mouth; 
the pavilion of the ear, when held to the light, ivas nearly diaphanous. 
When quiet, she experienced not the slightest inconvenience, and 
would not, she remarked to me, be conscious of any thing unusual 
in her situation. 

I now requested her to ascend a flight of stairs and return. On 
entering the room she threw herself into a chair, with an exclamation 
that *' she was nearly gone." She exhibited a picture of exhaustion. 
Her limbs hung relaxed, her head fell on her shoulder, she panted 
violently for breath. The throbbing above the sternum and on the 
sides of the neck was violent, but strongest on the right. The heart 
palpitated excessively — its contractions were tumultuous so as not to 
be counted, and were sharp and strong. This state continued about 
five minutes, when it began to decline, and gradually terminated. I 
examined with great care the right clavicular region, to discover the 
existence of a tumour, and though the pulsation was very distinct to 
the feel, yet nothing like a tumour could be detected. 

From a review of the case I could not arrive at a satisfactory con- 
clusion. I was strongly disposed to regard it as an aneurism or dilatation 
of the aorta, at its arch, or of the innominata. It resembled in many 



Jackson on Hematosis. 119 

respects the cases of aneurism recorded by Mr. Wardrop, especially 
his fourth case. Yet it exhibited many features of anemia; but as no 
losses of blood had been sustained, the symptoms could not well be 
attributed to that cause. In this uncertainty, I limited my directions 
to a reduction in some degree of the diet, to take a mild cathartic, 
and to keep perfectly quiet. 

The symptoms continued without abatement, and having a consul- 
tation with a friend who is engaged in surgical practice, I invited 
him to examine this case. After an attentive observation of the phe- 
nomena it presented, he was decidedly of opinion, that an aneurism 
of the aorta or innominata was the cause producing them. On the 
10th of January, acting on the impression of the existence of an aneu- 
rism, I directed YS. to §x. with an abstemious diet. 

The next day, 1 1th, all the symptoms were greatly aggravated. She 
was now scarcely able to leave her chair; every attempt to walk about 
the room excited panting and palpitations; the throbbing in the neck 
was more violent, and it was with difficulty she was got up stairs to 
bed. The blood drawn consisted almost entirely of serum, the crassa- 
mentum being very small. To relieve the urgency of the symptoms, 
warm wine whey, with a calming potion were ordered. I had no 
longer a doubt, from the result of the bleeding, that the case was one 
of anemia, or what is nearly of the same nature, a deficiency of the 
fibrin and hematosine of the blood. The following powder was pre- 
scribed; phosphas ferri, gr. v.; sulph. quinse, gr. ss. every four hours; 
the diet was made more generous. 

January lAth. Symptoms diminishing; palpitations lessened. Pow- 
ders continued. 

January 9.1st. Throbbing in the neck and above the sternum has 
diminished very considerably; she can now ascend and descend the 
stairs without the distress and faintness formerly experienced, though 
palpitations continue to be induced. Continue powders. 

January 2Sth. Progressive amendment; menstrual discharge re- 
turned; colour returning to the cheeks, lips, and tongue. Continue 
treatment. 

February 10th. Symptoms have entirely disappeared; complexion 
restored to its usual healthy aspect. Was last night at a dance, and 
experienced no inconvenience from the exertion. Omit the treat- 
ment. 

March IQth. Health continues perfect; exercises daily, and suffers 
from none of the former symptoms. 

Remarks. — The symptoms of the above case would probably be ac- 
counted for by many as nervous. But this term, unless it be defined 



120 Jackson on Heraatosis. 

and a positive idea attached to it, is no explanation of the phenomena, 
and can give no clue to a plan of treatment. It is not probable that 
they had their origin in the nervous system, for the mind and feelings 
were perfectly tranquil. The subject of the case is a girl of excellent 
sense, has never shown any tendency to a morbid sensitiveness of 
nerves, and moral impressions produced but slight effect in exciting 
the symptoms. Besides, we do not know that nervous affections, as 
they are termed, can occasion the disappearance of the hematosine or 
colouring principle of the blood. 

Taking a review of the whole of the preceding case, it appears to 
me evidently to have depended on a morbid alteration in the propor- 
tion of the constituent elements of the blood— the fibrin and hemato- 
sine or colouring principle being deficient. 

Case 2d. — Mrs. , aged twenty years, temperament highly lym- 
phatic, large frame, flesh soft, skiii of a bloodless white, hair and 
eyes light colour. Grew up rapidly, menstruated without difficulty, 
enjoyed good but not robust health until spring of 1827^ when she 
was attacked with chronic pneumonia, that threatened for nearly a 
twelvemonth to terminate in phthisis, but which was finally cured. 
Married in winter of 1828-9; her health since then has been imper- 
fect, though never sufficiently ill to require medical attendance. Be- 
came pregnant and was confined in the second week of February, 
1830. The accouchement, which was attended on by Dr. J. Moore, 
was remarkably easy. The two ensuing days she appeared unusually 
well, but on the third she complained of an incessant noise in her 
head, which entirely prevented sleep, and which alternated with pain. 
She was bled, leeched, and cupped in the head, and the bowels were 
freely evacuated by purgatives, without benefit. 

February 9XsU I was requested to visit Mrs. , in consultation. 

She continued to suffer terribly in the head, with distressing noise, 
which ceased occasionally and was replaced with pain; hearing so 
acute as to prevent sleep; mind not affected; skin, natural tempera- 
ture, of deathlike paleness; pulse 120, full and large, but having no 
force; tongue large, moist, and colourless s lips equally pallid; sto- 
mach quiet; abdomen soft and exempt from pain or soreness; lochia, 
which had been profuse, considerably diminished. From the extreme 
distress of the head, and apparent activity of the pulse, venesection 
was directed, and ^x. were drawn. The blood presented a small, 
loose coagulwn, floating in a large quantity of serum. 

No relief was experienced from the depletion; the pulse was more 
feeble, with equal frequency. Blisters were applied to the ankles, 



Jackson on Hematosis. 121 

and a calming potion, with sulph. morphiae and Hoftman's anodyne di- 
rected every two hours; blisters had produced Jine vesication^ hut 7iot 
the slightest colour. 

February 22c?. Some sleep was procured and head was less dis- 
tressed; pulse frequent, jerking, and empty. A mild tonic prescrib- 
ed. Evening. Solution sulph. morphise. 

February 23c?. Night had been very disturbed; delirious; voice tre- 
mulous; agitation; pulse 160, pulsations tumultuous; head very hot; 
legs cold; lochia suppressed; no pain; great thirst. Directed hair to 
be cut close to scalp; bladders of cold water to be constantly applied; 
warm fomentations to the abdomen and vulva; warm bricks to the 
lower extremities; tonic withdrawn. Noon. Symptoms on decline. 
6 P. M. Symptoms much abated; pulse slower and fuller; thirst les- 
sened; took some chicken water with relish. 

February 24th. Had some sleep last night; head very much re- 
lieved; cold constantly applied and extremely grateful; pulse slower; 
feels as if the contents of the artery had no consistency; tongue is 
very sore and painful; is pallid; papillae elevated and flat. 1 P. M. 
Stomach disturbed, vomits frequently; nausea constant, etherised 
potion. 10 P. M. Stomach relieved; has been taking at her own 
request, water with a small portion of wine; anodyne to-night. 

February 25th. Tolerable night; vomiting; nausea constant; pulse 
feeble, slower. Almond emulsion, table-spoonful every hour. 1 P. M. 
Nausea relieved. Poultice to vulva which is painful. Anodyne at 
night. 

February 26th. Very tranquil night; head is not troublesome while 
cold is applied, which has not been discontinued night or day; pulse 
nearly natural; bowels opened without medicine; intense craving for 
food, but disgust for whatever is brought to her; cannot make a choice 
to please herself; is no longer restless. 

February 27th. Restless, disturbed night; pulse feeble, frequent, 
140, and empty; constant nausea with occasional vomiting; skin cold 
with whiteness and semitransparency of alabaster. Infus. Colombo 
and wine sangaree; blister to epigastrium. 1 P. M. Infusion reject- 
ed by the stomach. 6 P. M. Blister drawn well, but entirely co- 
lourless; thirst very intense; frequent chills; pulse empty and feeble; 
hearing painfully sensitive. S. quinse, gr. iv. to be applied to the 
blistered surface, and repeated at 8 P. M. 10 P. M. Condition im- 
proved; skin warmer; pulse fuller. Sulph. morphiae, gr. ss.; sulph. 
quinae, gr. ij. to be applied to the blister, and repeated in two hours. 

February 2Sthc Comfortable night; craving for food ceased, and 



122 Jackson on Hematosis, 

replaced by that for fluids. Demand for a pleasant drink incessant, 
but none that can be thought of satisfies her; took some beer in the 
night, with an oyster, which provoked several watery stools; pulse 
weakened. Continue external application of sulph. quinae; chalk ju- 
lep to arrest diarrhoea. 6 P. M. Diarrhoea checked in afternoon. 10 
P. M. Craving for drinks unabated; pulse increased in frequency; 
complains of her head; noise returned. Discontinue the sulph. quinse. 

March 1st, Night tranquil; two watery passages; same difficulty 
with drinks, which are ardently desired; pulse fuller and slower. 
Brown stout diluted, with soup. 6 P. M. Relishes the brown stout; 
skin of better temperature, a disposition to moisture for the first time. 
Blister reapplied to epigastrium. Blistered surfaces continue colour- 
less; tongue continues very sore, is covered with a pellicle that is 
constantly thrown offand reproduced, (magnet.^ of the French.) Sulph. 
morphias applied to blister. 

March 9.d. Disturbed night; took some milk punch as well as the 
brown stout; feels weaker; pulse is feebler; frequent eructations with 
nausea; thirst distressing; diarrhoea. Abandon all internal stimulants; 
almond emulsion flavoured with prussic acid; sulph. quinae, gr. ii. to 
blistered surface every two hours. 6 P. M. Symptoms improving; 
pulse regained more vigour; eructations lessened; nausea ceased; skin 
warmer. Sulph. morphise to blister. 

March Sd. A good night; tongue in same state; thirst unabated; 
pulse and skin more natural. Mass. hydrargyri, gr. i. three times a 
day. 10 P.M. One serous stool. Sulph. quinse, gr. ii., sulph. morph. 
gr, i, to blister. 

March 4th, Pleasant night; tongue and throat very sore; pulse 
fuller and skin pleasant to the feel; lips have a slight pink tinge; 
feels some appetite and took coffee and toast with a relish; cold, at 
her own request, has been unceasingly continued to her head. 10 
P. M. Very much improved; took a longing for pork and cabbage, 
which ^e eat with great relish; feels better, pulse fuller and firmer; 
skin natural^ two alvine discharges, serous, but more consistent; 
poultice to the throat. Continue powders to blister, and pills. 

March 5th, Tolerable night; disturbed with uterine pains, which 
produced discharges of large masses of a gelatinous mucus from the 
uterus; improving. 

March 6th: Slept well; eat breakfast with relish; lips becoming 
coloured, and blistered surfaces have a faint blush. Continue treat- 
ment; throat sore. 

March 7th, Copious mucous expectoration; uvula coated with 
brownish exudation. Gargle of alum water. 



Jackson on He'matosis. 123 

March nth. Has continued improving; appetite natural and strong; 
alvine discharges natural; no strength. 

March Q.Oth. Been in favourable state; strength does not return; 
cannot sit up; very pallid; noise of head renewed and is distressing; 
pulse has no firmness; appetite excellent; bowels regular. Phosphas 
ferri, gr. v. ; sulph. quinae, gr. |. four times a day. 

March SOth, Has increase of strength; sits up occasionally and can 
walk with assistance; lips have more colour, but are yet unnaturally 
pallid. 

^pril 5th. Is gradually increasing in strength. 

Remarks. — In this case the almost total absence of the colouring 
principle of the blood, is a feature too obvious to be denied. The 
want of colour in the lips, gums, and buccal mucous membrane; the 
colourless state of the blistered surfaces, to which blisters were se- 
veral times reapplied, and which were dressed constantly with irri- 
tating substances, are positive evidences of this state. I have never 
before met with this circumstance to the same extent. No difference 
was to be discerned between the colour of the sound and blistered 
skin; the absence of the cuticle alone distinguished them. The blis- 
ters notwithstanding drew rapidly and the serous discharge was co- 
pious. 

The anemic condition, or more properly, deficiency of fibrin and 
hematosine, is not to be regarded as the essential character of the 
disease, in this case. It was a modifying circumstance, influencing 
the character of the symptoms and the treatment. The aff*ection was 
uterine, gastric, and cerebral irritation, the common consequences of 
accouchement. The vulva was also severely affected. The movements 
of the body for several days excited so much pain in this part, that 
the same position was constantly preserved, and all the evacuations 
were made into cloths. Notwithstanding the apparent necessity of 
depletion for the removal of extensive and acute inflammations, the 
state of the direct circulation and vascular system, entirely preclud- 
ed this measure, and other methods of controlling the inflammatory 
actions became necessary. The depressing influence of cold to the 
head, with the repulsive action of sinapisms, blisters, and heat to the 
lower extremities, subdued the cerebral excitement and kept it in 
check. There was no intermission to the application of cold water to 
the head for ten days. It was so grateful, the patient would not suf- 
fer it to be discontinued. The gastric irritation, which was not vio- 
lent, or excited apprehensions, was trusted principally to cooling and 
demulcent drinks. The unfavourable state of the circulatory func- 



124 Jackson on Hematosis. 

tionS) constituted a formidable obstacle. It could not be operated on 
in the first periods, through the stomach, nor bj the rectum, from the 
tumefaction and extreme soreness of the perinaeum and vulva. The 
endermic medication became here an invaluable resource. The appli- 
cation of sulph. quinse to the blistered surfaces, invigorated the organs 
of the general circulation, and what was of equal or of greater im- 
portance, gave force to the capillary actions in the skin, manifested 
by its increase of temperature. This was the operation the most de- 
sirable to be procured, as it constituted a powerful revulsive or con- 
trolling power, antagonizing the morbid irritations of the internal 
dermoid tissue or mucous membranes. 

This case establishes a principle of considerable importance. It 
demonstrates that redness is not absolutely essential to inflammation^ 
but depends solely on the hematosine of the blood. The intensity of 
the colour is not, then, in proportion to the activity of the inflamma- 
tory action, but to the quantity of hematosine, or colouring principle 
present in the blood. When this principle is deficient, as it was in 
the subject of this case, and as it often is in the highly lymphatic 
temperament, the colour of an inflamed surface will not correspond 
during life to the activity of the inflammation, and after death, no 
trace of it will remain, to indicate the extent of the previous morbid 
irritation. 

About a twelvemonth previous, an elder sister was affected in a 
manner precisely similar, and the case proved fatal. In that case 
there had been considerable uterine losses by flooding, and subse- 
quently a continual drain from haemorrhoids. The anemic condition 
was attended with gastric and cerebral irritation, but, from the ex- 
treme languor, feebleness, and disorder of the circulation, stimu- 
lants, and tonics were lavishly administered to maintain the strength. 
The most distressing state of the stomach was induced — the torments 
of thirst were unappeasable, while the fluids swallowed were im- 
mediately rejected by vomiting. The distress of the head was into- 
lerable, and ended in a partial apoplexy, with temporary loss of con- 
sciousness and speech. It would have been happy had it been more 
complete, and have prevented a death with a long and cruel agony. 

In the preceding cases, a deficiency in the process of sanguifica- 
tion or hematosis undoubtedly existed. But they throw no light 
on the cause of this defect. The process is complicated; it is the as- 
sociated action of several functions and numerous organs, and de- 
rangement in any one of them may render the whole operation abor- 
tive. Some of the actions essential to it are performed deep in the 



Jackson on Hematosis. 125 

organism, appertain to the most obscure and impenetrable of the phe- 
nomena of the organism, and hence elude observation. In the first 
case, several successive days of attentive examination, did not ena- 
ble me to discover the slightest aberration in the normal action of 
the organs, to which could be ascribed the peculiar state of the san- 
guineous fluid. It occurred suddenly in the full enjoyment of robust 
health, without prodrome, following on excessive exertion, want of 
rest, exhaustion and fatigue. 

A similar deficiency of colouring matter in the blood, is a common 
circumstance in the chronic affections of the spleen. But I have met 
with it, in several cases, as well as those above, in which no evi- 
dence of the slightest derangement of that organ could be discerned. 

It is not an improbable conjecture, that the colouring principle of 
the blood, is formed in the act of nutrition, in the capillaries and pa- 
renchyma of the organs, and subsequently, by venous absorption, is 
intermixed with the elements of the sanguine and nutritive humour. 
Hence the benefit that in almost every instance, I have found to be 
derived from the chalybeate and more permanent vegetable tonics, 
introduced into the organism, in a manner not to interfere with the 
digestive organs, when in an irritated state. The tonic and diffusive 
excitement of the mild mercurial preparations, gradually introduced, 
to avoid a pathological disturbance, are also of great utility in re- 
storing the healthy condition of the blood. Now the medication of the 
preceding remedies has a common character, which is to be perceiv- 
ed b}^ an analysis of the physiological phenomena, following their 
exhibition. It is a diffusive and permanent, or otherwise tonic excite- 
ment — a mere invigoration of the normal action of the capillary cir- 
culation, and functions of nutrition and secretion; and from this pro- 
ceeds the proper or healthy constitution of the blood. This explana- 
tion is, however, presented only as conjecture, and is to be received 
as such, until some more positive facts can be adduced in its sup- 
port. 



No. XL—May, 1850. 1£ 



126 



Lehman's Meteorological Observations. 



Art. IX. Meteorological Observations^ made in the City of Phila- 
delphia, Latitude 39° 57\ and on the Island of Tinicum, eleven 
miles south-west from Philadelphia, Latitude 39° 48', for the year 
1827.* Bj George F. Lehman, M. D. Lazaretto Physician of 
the Port of Philadelphia. 

JANUARY, 1827. 





FAHREN. 








THERMOM. 


WIXDS. 


WEATHER. 


1^ 


^ 




o 


o 






1 


23 


1H 






23 


N. W. fresh. 


Cloudy. Clear. Small snow. 


2 


25 


25 


W.,N.W. 


Cloudy. Clear. 


3 


27 


26 


s. w. 


Cloudy. Clear. 


4 


28 


28 


s. w., w. 


Clear. 


5 


25 


22 


N. W. 


Clear. 


6 


26 


28 


w. 


Clear. 


7 


23 


30 


N. E. 


Clear. Schuylkill and Delaware rivers 
frozen over. 


8 


33 


32 


N. E. 


Cloudy. Large rain. 


9 


33 


35 


N. W. 


Cloudy. Small rain. 


10 


38 


34 


N. E. 


Overcast. 


11 


37 


37 


N. E. 


Cloudy. Small snow at night. 


12 


34 


36 


N. E. 


Cloudy. Rain. 


13 


36 


33 


S. W. 


Cloudy. 


14 


34 


31 


N. W. 


Clear. 


15 


32 


32 


N. W. 


Clear. Cloudy. 


16 


33 


11 


S. W., N. W. 


Overcast. Clear. Wind fresh. 


17 


15 


14 


N. W. 


Clear. Delaware frozen up. 


18 


19 


16 


W. 


Clear. 


19 


20 


16 


N. W. 


Clear. Cloudy. 


20 


15 


16 


N. W. 


Cloudy. Clear. 


21 


19 


20 


N. W. 


Clear. Cloudy. 


22 


20 


28 


s. w. 


Cloudy. 


23 


29 


32 


S. E., W. 


Cloudy. Clear. 


24 


32 


24 


N. W. 


Clear. 


25 


28 


29 


N. W. 


Clear. 


26 


34 


38 


s. w. 


Cloudy. Clear. 


27 


39 


44 


s. w. 


Clear, Cloudy. Drizzly* 


28 


44 


40 


W., N. W. 


Cloudy. Clear. 


29 


37 


38 


N. W. 


Cloudy. Rain. 


30 


36 


36 


N. E. 


Cloudyv Drizzly. Clear. 


31 


36 


30 


N. W. 


Cloudy. Rain. Clear. 



* The observations were made in the city, for the months of November, De- 
cemberj January, February, March, April, and May, and the seventeen last days 
of October; and on the Island for June, July, August, September, and the first 
fourteen days of October. This year I have noted the thermometer at the hours 
of 10 A. M. and 10 P. M. as they no doubt would afford a truer mean tempera- 
ture than any others. From their inconvenience, however, I have been obliged 



Lehman's Meteorological Observations. 127 

Total rain during the month 2.70 inches. 

Mean temperature 29.6° Fahr. 

Maximum 44° 

Minimum 11° 

Range of thermometer 33° 

Hottest day, 28th.— Coldest days, 18th arid 20th. 

Darien, Geo. January 1st. — The mercury in the thermometer stood at 11° be- 
low the freezing point all day. 

Bostvn, Mass. January 2d. — The quantity of snow now on the ground is ap- 
parently greater than has fallen before at any one time for several years past. 
Yesterday afternoon at 2 o'clock, the mercury in the barometer had fallen to 
28.64, a depression altogether unprecedented in this city. 

Augusta, Geo. January 2d. — So excessively cold was tlie weather, that the 
river was actually frozen across last night. 

New York, January 6th. — Great quantities of ice is in the bay. At 3 P. M. 
the ice had choked the narrows, and prevented a passage. On the 29th ultimo, 
the thermometer at Bellows Falls, Vermont, was at 17° below zero. At Con- 
cord, New Hampshire, at 8 A. M. it was at 18° below zero. At Hallo well, 
Maine, 20° below zero. At Augusta, Maine, 26° below zero. 

Washington, B. C. January 7th. — A comet has been discovered for several 
evenings, visible at a small distance S. E. of the planet Mars. 

Charleston, S.'C. January 8th. — Cold weather equal to the present, has not 
occurred since the year 1780. It has continued from the 24th of December. 

Albany, N. Y. January 12th. — The snow fell to a considerable depth. This 
is the third fall of snow since the last of December, and the ground is now co- 
vered by an average depth of about two feet. An equal quantity has not fallen 
in the same space for forty years. 

Charleston, S. C. January 20th. — We have had a long continuance of cold 
weather. Fahrenheit's thermometer last night stood at 18°. At six o'clock 
this morning at 16°. 

Chester, Pa. January 22d. — The river Delaware, opposite Chester, and as far 
as the eye can reach, is completely frozen over, 

Boston, Mass. January 22d. — Our harbour is frozen over as far as Long 
Island, and there is much floating ice outside. 

Campbell's Station, Tenn. January 30th. — The wild pigeons have this day 
been passing this place, going north in great numbers. 

There was a frost in Havanna, in the Island of Cuba, this month, a circum- 
stance never before known. The coffee trees were not believed to have been 
injured. 

to discontinue them. The evening hour is especially inconvenient, as a light 
must always be taken very near the thermometer to examine it. 

In the last August number of the journal, in the meteorological observations 
for the year 1826, the mean temperature of July is given as 86.43°. It ought 
to be 76.73°, and the increase of heat from the preceding month, 4.56° instead 
of 14.26°. In August, 1826, the decrease of heat from the last month is stated 
as 10.86°, it is only 1.16°, and in the comparison with July, 1825, the mean 
temperature instead of being 6.06° greater in 1826, must be 4.56° less. 



128 * Lehman's Meteorological Observations. 
FEBRUARY, 1827. 





FAHKESr. 




i 

WEATHER. 




THERMOM. 


WINDS. 


^ 


^' 




< 

o 


o 








rH 


tH 






1 


36 


31 


N. W. 


Clear. 


2 


32 


36 


S. E. 


Cloudy. Snow. Rain. 


3 


37 


37 


s. w. 


Cloudy. Rain. 


4 


32 


29 


N., N. W. 


Cloudy. Sleet at night. 


5 


31 


32 


N. E. 


Cloudy. Rain all day. 


6 


40 


34 


N. W. 


Cloudy. 


7 


34 


33 


N. E. 


Cloudy. Clear. 


8 


37 


37 


S. W., N. W. 


Clear. The ice in the Delaware broken 
up. - 


9 


^7 


38 


E. 


Cloudy. Spitting" of snow. Ram. 


10 


42 


32 


N. W. 


Clear. Flying clouds. A flurry of snow 
at night from N. W. 


11 


39 


20 


N. W. very fresh. 


Cloudy. Clear. 


12 


25 


28 


N. W., S. W. 


Clear. 


13 


36 


41 


s., s. w. 


Overcast. Clear. Delaware obstructed 
by ice. 


14 


40 


36 


N. aV., W. 


Clear. 


15 


36 


43 


N. E. 


Cloudy. Snow. Rain all day and nigbt. 


16 


42 


44 


S. W.,N. W. 


Clear. 


17 


45 


40 


N. W. 


Clear. 


18 


44 


44 


s. w., w. 


Clear. 


19 


42 


33 


N. W. 


Clear. 


20 


36 


38 


N. W. 


Clear. 


21 


38 


54 


S. W. 


Hazy. Cloudy. 


22 


51 


43 


N. W., W. 


Clear. 


23 


42 


47 


N. E. 


Cloudy. Clear. 


24 


46 


45 


N. E., E. 


Cloudy. Hard I'ain. 


25 


42 


42 


N. E. 


Cloudy. 


26 


49 


45 


N. W. 


Clear. 


27 


44 


44 


N. E. 


Cloudy. Rain. 


28 


52 


50 


S. W. 


Cloudy. Rain. 


Total rain 


during the month 


3.60 inches. 


Mean temj 


)erature 


38.45° Fahr. 


Increase o 


" heat from last mot 


ith - - - - 9.39° 


Maximum 


- 


54° 


Minimum 


. 


. . - - - 20° 




Rang- 


e oft 


tiermometer - 


. . - 34° 



I 



Hottest days, 21st, 28th.— Coldest day, 11th. 

February 1st. — The Ohio river is now thirteen feet above low water mark. 
The ice broke up on the 30th of January. 

Keene^ N. H. February 2d. — The snow fell about ten or twelve inches. In 
the woods it is now four feet deep. 

Charleston^ S. C. February 5th.— The weather which was lately so severely 
cold for this climate, has been succeeded by a warmth not usually experienced 



Lehman's Mtteorolo":ical Observations. 129 



'O 



at this season. Fahrenheit's thermometer has been for several days past up to 
70 degrees. 

Greensburg, Fa. February 9th. — A vast quantity of snow fell during" the past 
week, the greater portion of which melted as it fell. Six inches deep, how- 
ever, of it remained when raining commenced, and continued until every par- 
ticle of snow had disappeared. This had a great effect upon the streams which 
were bound in ice, in some instances two feet thick. 

Fortland, February 12th. — The thermometer was 13° below zero. 

Mobile, Alabama, February 13th. — The present winter is noticed throughout 
the country, as being more severe than any that has been experienced for many 
years, particularly along the Atlantic coast. The weather was extremely cold 
here about the 16th of January, and ice made three or four inches thick. Since 
that time it has been unusually mild. Peach trees are now in blossom. 

Pottsville, Pa. February 17th. — Our sleighing yet continues. It has been 
good for a period of nearly seven weeks. The snow which fell at Christmas 
yet lies on the ground. 

Philadelphia, February 17th, — The river Delaware presented a beautiful 
sight: between thirty and forty vessels, ships, brigs, and schooners were seen 
proudly ascending it. The wharves were crowded with spectators. It was at 
this season a novel sight, as the Delaware had been frozen up since the 17th 
of January. 

Massachusetts, February 21st. — The whole depth of snow which has fallen 
this winter, is ascertained to be sixty-one inches. 

Williamsport, Lycoming County, Pa. February 22d. — It commenced raining, 
and continued without intermission for many hours, which cleared the river of 
ice, and raised the water about thirteen feet from low water mark. The ice 
had continued from the middle of December to this day. 

Vermont, February 23d. — The snow on the Green Mountains is more than 
six feet deep. 

Raleigh, iV. C. February 23d, and 24th, were excessively warm days. The 
thermometer was up to 76°. On the afternoon of the 24th, a tremendous storm 
of wind and rain prostrated trees, fences, and chimnies. 

Richmond, Va. February 24th. — The heat of the day was unusual for the sea- 
son, and in the evening a terrific thunder storm was experienced a few miles 
N. W. of this place. Several houses were unroofed, and completely despoiled. 

Charleston, S. C. February 27th. — Our winter has been unusually severe, and 
marked by great peculiarities. At the beginning of the year, Fahrenheit's 
thermometer at six o'clock in the morning, was as low as 14° above zero, and 
in thirty hours after, in the same spot, it rose to 68°. In consequence of the 
mildness of the weather in the present month, all our fruit trees are in blos- 
som. Last night a thunder storm occurred, accompanied by vivid flashes of 
lightning, and torrents of rain and hail. 

Little Rock, Arkansas Territory, February 27th. — The weather continues re- 
markably fine. Peach trees are in full bloom, and the forests already resound 
with the notes of a variety of birds. 

St. Johns, N. B. February 2Sth. — It is a curious circumstance that there has 
not fallen, during the present season, a sufficient quantity of snow to cover tlie 
ground. 

12* 



130 Lehman's Meteorological Observations. 

MARCH, 182r. 





FAHREN. 








PI 


THERMOM. 


WINDS. 


WEATHER. 




^ 


^ 




•< 


P4 










O 


o 

r-t 








1 


42 


40 


N. E. 


Cloudy. Rain. 




2 


38 


40 


N. W. 


Cloudy. Clear. 




, 3 


42 


31 


N. W. 


Clear. 




4 


36 


36 


N. E., S. E. 


Overcast. Clear. 




5 


43 


38 


N. E. 


Clear. 




6 


43 


40 


N. E. 


Overcast. Cloudy. Rain. 




7 


42 


44 


S. W., N. W. 


Cloudy. Clear. 




8 


48 


50 


N. W., S. W. 


Clear. 




9 


52 


48 


N. W. 


Overcast. Clear. 




10 


50 


46 


N. W. 


Clear. 




11 


51 


45 


S. W., N. W. 


Clear. 




12 


50 


5e> 


S. E. 


Overcast. Cloudy. Rain. 




13 


52 


40 


W., N. W. 


Clear. 




14 


41 


35 


S. w., w. 


Cloudy. Snow all the afternoon, 
melted as it fell. 


which 


15 


:^7 


41 


N. W. 


Overcast. .Clear. 




16 


44 


44 


N. W. 


Clear. 




17 


48 


44 


N. W. 


Clear. 




18 


50 


53 


S. E. very fresh. 


Cloudy. Large rain. 




19 


52 


40 


W., N. W. 


Cloudy. Rain. 




20 


42 


39 


N. W. 


Clear. Cloudy. Small rain. Weather | 










variable. 




21 


36 


44 


N. E. 


Clear. Shower at night. 




22 


50 


60 


s. w. 


Clear. 




23 


56 


44 


N. W. 


Clear. 




24 


42 


42 


N. W. 


Clear. 




25 


46 


50 


S. E., S. 


Clear. Cloudy. 




26 


54 


60 


S. W. fresh. 


Cloudy. Clear. 




27 


62 


62 


S. W. 


Clear. Shower before daylight. 




28 


59 


44 


N. W. 


Cloudy. Clear. 




29 


51 


45 


N. W. 


Clear. 




30 


48 


48 


N. W. 


Clear. 




31 


52 


43 


s. w. 


Overcast. Clear. 





1.36 inches. 

45.61° Fahr. 

7.16° 

62° 

35° 

27° 



Total rain during the month - - - - 

Mean temperature - - - 

Increase of heat from last month - - - 

Maximum 

Minimum - 

Range of thermometer 

Hottest day, 27'th.— Coldest days, 4th, 14th. 

March \st. — The first ark descended the Susquehanna river this season on the 

28th of February. Several arks descended on the 1st, 2d, and 3d of March. 

This is unprecedented, arks not generally going down until the latter end of 

March. 

Pottsville, Schuylkill County, Pa. March 3d.— In consequence of copious w^arm 



Lehman's Meteorological Observations. 13X 

Tains carrying off the snow from the hills, and the ice from the canal, dams, 
and streams, the waters of this county have been much raised. 

Piitsburghf Fa. February 9th, — The river is seven feet and a half above low 
water mark. 

Charleston, S. C. March 10th. — As a proof of the mildness. of the season, we 
may mention, that a full grown rattlesnake, twelve years old, was caught a few 
days ago. 

New York, March 11th. — Fahrenheit's thermometer stood in the shade at 65°, 
and from the flight of the wild geese, we may expect uninterrupted freedom 
from cold. 

Charleston, S. C. March 12th. — The spring has set in early; our fruit trees 
have been for some time in blossom. Green peas were sold in the market on 
Saturday last. 

JVew Haven, March 13th. — A fine shad was exhibited, which was caught in 
Concord river. 

Savannah, Geo. March 14th. — The market is already supplied with the flowers 
and vegetables of spring in considerable abundance. Green peas have made 
their appearance. 

Greensburg, Fa. March 16th. — For some time past, the weather has been un- 
commonly mild, so as to induce the feathered throng to take possession of our 
groves and house-tops. The shrubbery had nearly unfolded their buds, and all 
nature seemed about launching into new life, when the winds began to blow, 
the snow descended, and now all looks bleak and dreary. 

Charleston, S, C. March 17th. — A very sudden change of weather has taken 
place within the last two or three days, which from being temperate, has as- 
sumed all the severity of winter. On the night of the 15th, there was ice. 

Fennsylvania, March l^th. — The snow is two feet deep on a level in the 
neighbourhood of Lackawaxen. 

Reading, Fa. March 27th. — About midnight, a hurricane accompanied with 
rain, was experienced in this borough, and in the northern part of the county. 
Several houses and barns were unroofed, south of Kutztown, and trees torn up 
by the roots. 

Lewisiown, Fa. March 27th. — At night this borough and its vicinity was visit- 
ed by the most fearful storms of wind. Its effects were truly appalling — houses 
unroofed, and sheds and stables blown down. Almost every house has suffer- 
ed more or less. 

Hartford, Conn. March 29th, 30th. — The water rose over the banks of the 
Connecticut river higher than it has risen since 1807. The rise is more than 
twenty feet. 

Albany, JV. Y. March 30th. — The following is the quantity of snow that fell 
during the past winter: — December, four inches? January, forty-two inches? 
February, fourteen inches? March, three inches; total, sixty-three inches, equal 
to five feet and three inches, to which the memory of the oldest inhabitants can 
produce no parallel. 

Quebec, March. — More snow fell in this month than has fallen since the open- 
ing of winter. 



132 Lehman's Meteorological Observations. 

APRIL, 1827. 





FAHEEN. 




• 


02 

< 


THERMOM. 


WINDS. 


WEATHER. 


'k 


^ 




< 


p? 








o 


o 








T-i 


tH 






1 


43 


43 


N. E., N. 


Cloudy. Clear. 


2 


50 


53 


S. W. 


Clear. 


3 


60 


58 


s. w. 


Overcast. Clear. 


4 


64 


64 


s. w. 


Overcast. Rain at night. 


5 


er 


60 


s. w. 


Overcast. Rain heavy. 


6 


60 


60 


s. w., w. 


Cloudy. Clear. 


7 


61 


54 


N. W. 


Clear. 


8 


62 


59 


s. w. 


Clear. 


9 


56 


62 


E., S. E. 


Cloudy. Rain. 


10 


62 


65 


S. W. 


Overcast. Clear. 


11 


64 


68 


N. W. 


Hazy. Clear. Rain at night, with light- 
ning and thunder. 


12 


68 


64 


s. w. 


Cloudy. Clear. 


13 


61 


61 


s. w. 


Clear. 


14 


63 


61 


N. W. 


Hazy. 


15 


60 


63 


N. W. 


Cloudy. Clear. Drizzly A. M. 


16 


o& 


45 


N., N. W. 


Cloudy. Rain. Clear. 


17 


52 


50 


N. W. fresh. 


Clear. Overcast. 


18 


55 


51 


N. W. fresh. 


Clear. 


19 


57 


58 


N. 


Clear. Cloudy. 


20 


57 


55 


N. E. 


Clear. 


21 


56 


61 


S. W. 


Cloudy. Drizzly. 


22 


61 


58 


N. W. 


Clear. 


23 


58 


55 


N. E. 


Cloudy. Rain. 


24 


58 


55 


N. E. W. fresh. 


Cloudy. Large rain, with lightning and 
thunder. 


25 


48 


50 


N. W. fresh. 


Overcast. Clear. 


26 


47. 


50 


N. W. 


Clear. 


27 


57 


52 


N. W., S. 


Clear. Cloudy. Rain. 


28 


52 


52 


S. E. 


Cloudy. Large rain. Clear. 


29 


52 


49 


S. W. 


Overcast. Drizzly. Clear. 


30 


58 


50 


N. W. 


Flying clouds. Cloudy. 



2.90 inches. 
56.51° Fahr. 
10.90° 
68° 



4o- 

25° 



Total rain during the month ... - 

Mean temperature 

Increase of heat from last month - 

Maximum 

Minimum 

Range of thermometer 

Hottest days, 11th, and 12th.— Coldest day, 1st. 
^prillst and 2d. — Severe gales of wind, accompanied by rain, were expe- 
rienced in Charleston, S. C. and on the coast of North Carolina. 

Trenton, iV. /. April 2d. — The genial warmth of the sun, and salutary rain 
last week, is clothing our fields with green, and some of the early fruit trees 
are in bloom. The Delaware river continues high. 



Lehman's Meteorological Observations. 133 

Norristown^ Pa. Ji'pril lOih. — The weather is remarkably fine. Vegetation 
progresses with a rapidity unequalled for a number of years. 

Mecklenburg, Va. April 10th. — About five o'clock, a tremendous storm of 
hail and rain occurred. The hail-stones were from the size of a musket ball to 
a hen's egg". The hail was succeeded by a very heavy storm of rain and wind. 

Sunbury, Fa. Jlpril 10th. — In the afternoon a storm blew up from S. S. W- 
accompanied by lightning and thunder. A barn was struck by lightning, and 
entirely consumed. 

Montreal, April 11th. — The river near this, city is now clear of ice. On the 
4th it broke up. 

Morristown, JV. J. April V2ih. — The present season as yet has been charac- 
terized with the steady and uniform mildness which was common in our climate 
some fifteen or twenty years since. The soft, westerly breezes, and seasona- 
ble showers have mantled the earth with more of vegetation than of late years 
we have beei) accustomed to witness for perhaps even a month or six weeks 
later. 

Trenton, N. J. April 14th. — Large supplies of shad were brought to our 
market. 

Norristown, Pa. April 17th.~^ln the morning we had a heavy frost. The 
thermometer at six o'clock was as low as 36°. 

Georgetown, S. C. April 21st. — After several excessively warm days, we ex- 
perienced a violent thunder storm, accompanied with a heavy shower of rain. 
On the 23d, the wind blew with so much violence, as to strip the branches from 
the trees, and prostrate fences. 

Reading, Pa. April 24th. — Never did vegetation appear better, or more for- 
ward at this season of the year, than it does now. The slight frosts which lately 
visited us, appear to have done no injury. 

York, Pa. April 26th. — New potatoes are in our market for sale. 

Petersburg, Va. April 27th. — The weather has been cool for the last two or 
three days, and yesterday morning our fields and gardens were whitened with 
frost. This day week, green peas and strawberries were in our market, luxu- 
ries which are not ordinarily obtained before May. 



Columbia, S. C. May 5th. — For several days past, the "weather has been un- 
usually cold. On the 3d, there was considerable frost, and the young corn has 
been injured. 

Philadelphia, May 7th. — Green peas are in our market. 

Wilkesborough, N. C. May 11th. — A pretty severe shock of an earthquake 
was felt here. 

Montgomery County, Pa. May 16th. — The Hessian fly is committing its ra- 
vages amongst the wheat. They are also destructive in some parts of West 
Chester. 

New York, May 19th. — A meteor was seen about nine o'clock in the even- 
ing, in the vicinity of Ursa Major. 

Hagerstown, Md. May 24th. — Many farmers in this county have ploughed up 
their wheat fields, and put in corn. Itis supposed that the best fields will afford 
but little more than half a common crop. 



134 Lehman's Meteorological Observations. 

MAY, 1827. 





FAHREIf. 






•< 


THEBMOM. 


WIJfDS. 


WEATHER. 


S 


i^ 




-4 


PM 








O 

r-l 


o 






1 


51 


46 


N. W. 


Clear. Overcast. 


2 


54 


54 


N. W. 


Clear. 


3 


55 


56 


N. W. 


Clear. 


4 


56 


57 


s. w. 


Clear. 


5 


61 


62 


s. w. 


Clear. 


6 


69 


64 


s. w., s. 


Clear. Cloudy. Rain. 


7 


55 


48 


N. W. 


Cloudy. Drizzly. Clear. 


8 


55 


54 


N.W. 


Clear. 


9 


60 


60 


S. W. 


Clear. 


10 


59 


52 


N. E. 


Cloudy. Large rain. 


11 


56 


57 


N. W. fresh. 


Clear. Overcast. 


12 


62 


56 


N. W. 


Clear. 


13 


62 


57 


N., N. W. 


Clear. 


14 


58 


61 


S. W. 


Clear. 


15 


59 


60 


E. 


Overcast. 


16 


63 


65 


N.W. 


Clear. 


17 


72 


68 


N. 


Hazy. Clear. 


18 


71 


68 


N.W. 


Clear. 


19 


70 


59 


N. W., E. 


Clear. 


20 


62 


57 


S. W., N. E. 


Clear Cloudy. 


21 


58 


62 


S. E. 


Cloudy. Rain. 


22 


62 


65 


S. E. 


Rain. 


23 


61 


64 


S. E. 


Cloudy. 


24 


60 


63 


S. E. 


Cloudy. 


25 


65 


65 


N. E., E. 


Clear. 


26 


74 


77 


S. W. 


Clear. 


27 


7o 


78 


S. W. 


Clear. 


28 


71 


68 


S. 


Overcast. 


29 


60 


59 


N. W. 


Cloudy. " 


30 


64 


72 


w., s. w. 


Clear. 


31 


65 


72, 


S. W. fresh. 


Clear. Cloudy. Rain, with thunder and 
hghtning-. 



Total rain during the month - - - - 

Mean temperature. 

Increase of heat from last month - 

Maximum 

Minimum 

Range of thermometer 

Hottest days, 26th and 27th.— Coldest day, 1st. 
Norfolky Va. May Ist.Kt noon a sudden and severe storm of wind and rain 
from N. N. W. swept over this town. It continued for about an hour, and some 
snow fell during the tempest. The weather has been for many days at the 
temperature of fall. 



2.40 inches. 

61.48° Fahr. 

4.97° 

78° 

46° 

32° 



Lehman's Meteorological Observations. 
JUNE, 1827. 



135 





FAHREJf. 


' 






THERMOM. 


WIKDS. 


WEATHER. 




. 


< 
P 


O 


8 

Ph 
O 






1 


59 


60 


N. W. fresh. 


Overcast. 


2 


61 


59 


N. W. fresh. 


Clear. Thermom. 49° at sunrise. 


o 


60 


58 


W., S. fresh. 


Hazy. Cloudy. Rain at nig-ht. 


4 


61 


60 


N. E., S.E. 


Cloudy. Rain. Clear. 


5' 


70 


62 


N. E. 


Clear. 


6 


69 


67 


N. E. 


Clear. 


7 


69 


69 


N. E. 


Overcast. 


8 


72 


68 


N. E. 


Cloudy. Smart rain at nig-ht. 


9 


74 


71 


s. w. 


Clear. Cloudy. Rain at night, with vivid 
lightning- and thunder. 


10 


74 


65 


N. W. fresh. 


Clear. 


11 


67 


69 


N. W., S. 


Clear. 


12 


70 


68 


S. W. fresh. 


Clear. 


13 


70 


70 


S. W. 


Clear. 


14 


75 


72 


S. E. 


Hazy. Cloudy. Rain, with lightning and 
thunder. 


15 


76 


74 


N. W. 


Clear. 


16 


78 


70 


N. E. 


Clear. 


17 


72 


66 


N. W. fresh. 


Clear. 


18 


64 


66 


N.W.,S.W. fresh. 


Clear. 


19 


70 


64 


S. W., S. E. fresh. 


Clear. 


20 


72 


70 


S. a g-ale. 


Hazy. Cloudy. Drizzly. 


21 


72 


74 


S. W. fresh. 


Cloudy. Drizzly. Rain, with thunder and 
lightning-. 


22 


70 


58 


S.W.,N.W. fresh. 


Cloudy. Rain. Clear. 


23 


62 


60 


N. W. fresh. 


Clear. Frost at dayhght. 


24 


60 


66 


N. W., S. 


Clear. 


25 


70 


68 


S. VV., S. E. 


Clear. Cloudy. Rain at dayhght. 


26 


68 


70 


S. W. 


Cloudy. Large rain, with lightning and 

thunder. 
Overcast. Cloudy. Rain. 


27 


7Q 


73 


S. W. fresh. 


28 


73 


74^ 


S. W. 


Cloudy. Drizzly. Clear. 


29 


74 


72 


N, W. 


Clear. 


30 


76 


75 


s. w. 


Clear. 



. Total rain during the month - - - - - 

Mean temperature 

Increase of heat from last month . - - - 

Maximum ... 

Minimum --- = ---- 

Range of thermometer - 

Hottest day, 16th.— Coldest day, 3d. 
Greensburgf Pa. June 1st. — This neighbourhood was visited by a severe frost, 
which totally destroyed the beans and corn in our gardens and fields. The 
frost was severe at Chambersburg-, but uncommonly so at Somerset, where the 
fruit is generally destroyed, and the corn frozen to the ground. 



2.70 inches. 

68.20° Fahr. 

6.72° 

78° 

58° 

20° 



136 Lehman's Meteorological Observations. 

Banvilk, Vt. June 4th. — A hail storm occurred. Some of the stones were as 
large as partridge eggs, and the ground was covered with them. 

Charleston, S. C. June 11th. — The summer has not been ushered in for many 
years Vi^ith such a singularity of aspect, as it has been the present year. The 
current month has been unusually cool. Since the 9th, however, it has resumed 
its usual character. 

Quebec, June 14:th. — During a severe thunder storm, the thermometer fell 
from 92° to 66° in three hours. 

Augusta, Geo. June 14th. — Peaches and water melons were in the market, 
and green corn has been exhibited in Norfolk, Virginia. 

June 14th. — Baltimore was visited by a severe thunder storm. An immense 
body of rain fell at the same time. Several mill-dams were swept away, and 
the cellars in some parts of the city were filled with water. 

Pottsville, Fa. June 17th. — In the night we had frost. Our streams are low, 
and the soil of our gardens dry as dust. There was also frost in Cambria and* 
Centre counties. 

Salem, Mass. June ISth. — We were visited by a storm of thunder and light- 
ning of unusual duration. The electric fluid struck several buildings. 

Mobile, Alabama, June \9th. — An extraordinary drought has prevailed in all 
the lower part of the state, which has very seriously injured the crops of corn 
and cotton, particularly the former. The drought has been accompanied pretty 
much throughout the month of June with hot weather. 

Pittsburg, Pa. June 19th.— Yov two months past the weather has been rather 
unusual. Many refreshing showers, with a good degree of general warmth, 
have promoted vegetation; but several sharp frosts have given it a check, and 
even so late as yesterday morning considerable frost was seen in the low grounds 
in the direction of Cranbeny Plains of Butler County. 

Washington City, D. C. June 22d. — At night there was a severe frost in our 
neighbourhood, which has done some injury. 

Armstrong County, Pa. June 22d. — There was a severe white frost. On the 
morning of the 23d, ice was made as thick as window glass. 

June 24ih and 25th. — In the District of Quebec, severe frosts were expe- 
rienced in the night. The tender vegetables sustained considerable injury, and 
the leaves of the forest trees bore testimony to the severity of the cold. 

Goshen, N. Y. June 25th. — The north-west part of our county was visited by a 
most extraordinary hail storm, destroying in its course many acres of beautiful 
grain. The size of the hail-stones were from three-quarters to an inch in dia- 
meter. Many panes of glass were broken. On the day after the storm, large 
quantities of hail were collected and deposited in ice houses. 

Charleston, S. C. June 25th. — The thermometer, which on the 21st and 22d, 
ranged from 80° to 84°, gradully sunk down to 60° in the night of the 22d, af- 
ter a thunder gust, and a heavy fall of rain. On the 23d, the wind was east and 
north. It is still very cool, and warm covering is agreeable. 

Greensburg, Pa. June 27th. — About twelve at night this village was visited 
by a thunder storm, which continued until nearly daylight. 



Lehman's Meteorological Observations, 
JULY, 1827. 



137 





FAHREK. 








THEKMOM. 


WINDS. 


WEATHER. 


. 


. 


< 


S 


S 






P 












-k 


(H 


V 






O 

tH 


o 






1 


82 


78 


s. w. 


Hazy. 


2 


06 


76 


W., N. W. 


Clear. Cloudy at 7 P. M.— wind N. W. 
with rain, thunder, and li^htnin^. 


3 


86 


82 


N. W., S. W. 


Clear. 


4 


86 


75 


S. W. fresh. 


Clear. Cloudy at 5 P. M.— wind N. W. 
with rain. 


5 


76 


70 


N. W. 


Clear. 


6 


75 


70 


N. W. fresh. N. E. 


Clear. 


7 


76 


72 


S. E., S. fresh. 


Clear. Cloudy. 


8 


71 


70 


S. by E. fresh. 


Cloudy. Large rain. 


9 


72 


73 


E. 


Cloudy. Clear. 


10 


72, 


73 


E., S. E. 


Overcast. Clear. 


11 


74 


76 


S. fresh. 


Cloudy. Large rain. 


12 


80 


78 


S. W. fresh. 


Hazy. Wind variable from N. W. and S. W. 
with thunder and lightning. Stormy and 
drizzly. 


13 


83 


78 


N. W. 


Clear. 


14 


83 


75 


S.W.,N.W. fresh. 


Clear. Cloudy. Large rain, with thunder 
and lightning. 


15 


81 


80 


N. W. 


Clear. 


16 


67 


68 


N.W. 


Cloudy. Rain A. M. Clear. 


17 


72 


71 


N. W., S. E. fresh. 


Clear. 


18 


74 


71 


N. W. 


Clear. 


19 


74 


71 


N. W., S. E. 


Clear. 


20 


78 


78 


S. W. fresh. 


Clear. 


21 


7^ 


69 


N.W. 


Overcast. Clear. 


22 


70 


70 


N. W. 


Clear. Thermom. 58° at daylight. 


23 


71 


67 


N. E. fresh. S. E. 


Overcast. 


24 


68 


65 


N. E. fresh. 


Cloudy. 


25 


71 


68 


S. E. fresh. 


Overcast. Small rain at night. 


26 


74 


70 


N. W. 


Clear. 


27 


72 


72 


N.W.,S.W. fresh. 


Clear. 


28 


74 


76 


s. w. 


Clear. 


29 


78 


74 


N.W. 


Clear. 


30 


75 


76 


N., N. E. 


Clear. 


31 


80 


1 75 


1 E., S. W. 


Clear. 



Total rain during the month 3.08 inches. 

Mean temperature - - - . ■ . . 74.34° Fahr. 

Increase of heat from last month . - - . 6.14° 

Maximum - 86°. 

Minimum 65°. 

Range of thermometer - 21°. 

Hottest day, 3d.— Coldest day, 24th. 
West Chesieff Pa. July 3d. — The thermometer at 3 P. M. in the shade was 
92 J degrees. 

No. XI — May, 1830. 13 

\ 



1 38 Lehman's Meteorological Observations, 



a 



St. Louis, Missouri, July 5th. — A shock of an earthquake of about a minute's 
duration, was felt in this city this morning- at half past five o'clock, accompanied 
by a lou'd rumbling' noise. 

July 7th. — The Ohio river at Wheeling is four feet and a half above low water 
mark. 

Lancaster, Ohio, July 14^A. — A large meteor was seen towards the east by the 
inhabitants of Pleasant Township, Fairfield county, between four and five 
o'clock, P. M. passing with great velocity towards the north. The reflection 
of the sun on the body of the meteor gave to it a most splendid and beautiful 
silver colour. An explosion was heard about twelve minutes after it passed 
resembling a large cannon. 

Tuscaloosa, Alabama, July 14:th. — Our crops are burning up in this part of 
the country. Even the winds, which are generally refreshing, seem to have a 
scorching influence. The mercury in the thermometer was at 100° in the 
shade on Wednesday last. We have not had rain enough even to refresh our 
corn-fields, for many weeks. 

Salem, Mass. July 18th. — A violent thunder storm passed over this town. The 
clouds had been gathering in the north-east during the afternoon, and about sun- 
set they burst over us in heavy showers, accompanied with lightning. 

New Orleans, Louisiana, July 21st. — The river has fallen this week seven 
inches. The weather continues dry and warm. 

Mobile, Alabama, July 21st. — The long drought which we had experienced in 
common with all this section, has within the last ten days been succeeded by 
tolerably copious showers of rain, and vegetation is reviving. 

New York, July 23d. — At half past nine o'clock, a meteor was observed. Its 
course was from near the zenith northwardly, and described an arc of about ten 
degrees. Its trail, which was of a bright red, continued luminous in its whole 
length, until the explosion, which was not distinctly heard. 

Portland, Maine, July 26th. — We were visited in this vicinity by a cold rain 
storm. Twenty-four miles distant, in the town of New Gloucester, the atmos- 
phere was filled with snow, none of which, however, retained its form long 
enough to reach the earth. 

Savannah, Geo. July 28th. — During the week the daily extremes of the ther- 
mometer have been from 82° to 88°, and once or twice has reached 90° and 91°. 
Frequent, though not heavy showers, have visited us during the same period; 
wind south. 

New Orleans, Louisiana, July 28/A.— The weather is very warm, with occa- 
sional light showers. 

Charleston, S. C. July 30th. — Since the summer of 1817, the city has not been 
visited at this period of the year, with such heavy and continued rains. During 
the whole of last week, it rained day and night, with few and partial intermissions. 

It is rather a curious circumstance that the severe gale and cold of the 23d 
and 24th ultimo, was felt along the course of the St. Lawrence, as far as the 
head of Lake Erie, at Washington City, and the New England states in the 
same days. 

It appears that a greater number of deaths from lightning have occurred this 
season than usual. 

fTo be continued. J 



1 



( 139 ) 



REVIEWS. 

Art. X. 1. CoRvisART. £ssai sur les Maladies et les Lesions Or- 
ganiques du Cosur et des gros Vaisseaux. 

2. Burns. Observations on some of the most frequent and important 

Diseases of the Hearty 8fc. 

3. Bertin. Traits des Maladies du Cceur, et de gros Vaisseaux. 

4. Reeder. .y? Practical Treatise on the Diseases of the Hearty <^c. 

5. Brown. Medical Essays on the Diseases of the Heart, ^c. 

6. DuNDAs. ^n .Account of a Peculiar Disease of the Heart. — Med. 

Chirurg. Trans. Vol. I. 

7. Wells. On Rheumatism of the Heart. — Transactions of a So- 

ciety for Improvement of Medical Knowledge, Vol. III. 

8. James. On Diseases of the Heart. — Med. Chirurg. Trans. Vol. 

VIII. 

9. Laennec. Treatise on the Diseases of the Chest, ^^c. fyc. Trans- 

lated from the French. Bj John Forbes, M. D. &c. &c. 
10. Martinet. Manual of Pathology, 8fc. Sec. — Translated from 
the French. By Jones Quain, M. D. 

v^ARDIAC diseases seem not till lately to have been investigated 
with care, and hence our knowledge of the subject was slight, vague, 
and confused. Early in the present century, however, it began to 
solicit attention, a closer mode of inquiry was instituted, and we 
have now attained to far more distinct and enlightened views, though 
still there is probably no portion of pathology of much greater ob- 
scurity. It has occurred to us, that we might, perhaps, render an 
acceptable service to our readers, by preparing a synopsis or digest 
of the matter which is now diffused through various writings little 
known we suspect to many, and accordingly in the execution of this 
design, we have consulted the numerous authorities at the head of 
this article. Content, as we must be, from the narrowness of our li- 
mits, to aim chiefly at what we may deem most interesting, we shall 
on all points avoid minuteness of discussion, and hope rather to sti- 
mulate the curiosity of the medical mind of our country to the perusal 
of the works themselves, which we have indicated, than to satisfy it 
by the information we shall communicate. 

The heart, and its immediate connexions, form a very complicated 
machine for the momentous purposes of the circulation, consisting of 
diverse structures, each part of which is exposed to derangements, and 



140 Diseases of the Heart. 

each of which derangements has been made, in some degree, a separate 
disease. Difficult in itself, the subject is rendered the more embar- 
rassing by these minute divisions, and artificial refinements. We shall 
endeavour to escape from this error, bj introducing a simpler classifi- 
cation, in which practical convenience may be better consulted. Not 
a few of the affections, occasionally described, will be entirely exclud- 
ed as of little importance, hard to be recognised or discriminated, 
and requiring no peculiarity of treatment. Those which may claim 
our attention, will be grouped together when practicable, according 
to their affinities, so as to present a more compact generalization. 

It seems to be confessed, that cardiac diseases, within a short pe- 
riod, have become more numerous than formerly, or, at all events, 
more frequently noticed. No doubt can well be entertained of the 
fact, and perhaps, in seeking the true explanation of it, each of these 
suggestions should have its weight. The subject, having excited a 
livelier interest, more perspicacity has been applied to it, and instances 
are observed or disclosed, which, with less care and penetration, might 
have eluded detection, or even the suspicion of their existence. Grant- 
ing this, however, there are circumstances in the constitution, and rela- 
tions of the central organ of the circulation, which expose it at certain 
seasons, more especially, to morbid aggressions. Extensively con- 
nected with the corporeal structure, it is scarcely less influenced by 
moral impulses, and hence, is doubly susceptible to baneful impres- 
sions. 

CoRvisART affirms, that during the perilous scenes of the French 
revolution, the diseases of the heart, in all their grades and modifica- 
tions, multiplied to an enormous extent, affording him the instigation 
to, as well as the amplest advantages in, the cultivation of this pro- 
vince of pathology. The same remark is made by Testa, in relation 
to the more recent revolution in Italy. Common experience, in a 
narrower sphere, abundantly illustrates the effects of mental emo- 
tions, or intense moral excitements, in disturbing, or more seriously 
aftecting, the function, or organization of the heart. 

Civilization, by creating a finer sensibility, and a wider surface to 
act upon, conduces in all its tendencies to this end. Every step of 
our progress, from the complexity of the social relations, is environ- 
ed by some possible annoyance, even in the happiest times of peace 
and tranquillity. The turmoils of public concerns, the cares of pri- 
vate business, the mortifications of pride, the disappointments of am- 
bition, the reverses of fortune, the ingratitude of friends, the persecu- 
tions of enemies, the sufferings of ill-requited love, the anguish of 
domestic afflictions, and above all, the humiliations of disgrace, are 



Diseases of the Heart. 141 

so many corrosives of feeling, and vultures of the heart. Mental per- 
turbation of a different kind is not always without a similar effect. 
Exacerbated rage, vehement terror, exuberant joy, and other exces- 
sive emotions, have sometimes suddenly extinguished life by an un- 
due rush of blood on the heart, or laid the foundation for a slower le- 
sion of that organ. Classic history supplies several well known ex- 
amples of the former, and the fact of the venerable janitor of the con- 
gress of our revolution, expiring in the plenitude of exultation^ from a 
rupture of his patriot heart, on the reception of the intelligence of one 
of the most glorious events of the times, is fully attested. 

In assigning so much to these moral agencies in the production of 
cardiac disturbance, we are aware that the ascertained nervous con- 
nexion between the heart and the brain, is not generally supposed of 
that intimate or ample character, to warrant the conclusion to the ex- 
tent we have assumed. But " there are many things in our philosophy 
not dreamt of by the mere anatomist. Even he, however, has shown 
that such a relation does exist, though slight — and, without recurring 
to the proof afforded by direct experiment of the reciprocal influence 
of these organs on each other, or other physiological considerations, 
an appeal may be safely made to common observation, in support of 
the fact of the violent and tumultuous agitation of the heart by men- 
tal impulses. 

The preceding are some of the sources of cardiac irritation in po- 
lished society, from which the lower orders have comparatively an 
immunity. But they are subjected to causes of another description 
which, perhaps, operate no less powerfully. Destined to the perform- 
ance of the coarser and more toilsome occupations, their exertions 
are strenuous, and unremitting, whereby, the circulation is accele- 
rated, and the heart unduly labours, which state by continuance may 
eventuate in functional or organic lesions. Conducted in the open 
air, and applied to the ordinary employments, such efforts do not of- 
t^n produce any essential injury. But very difterent is the result, in 
all probability, when carried on in those wretched manufacturing es- 
tablishments, which the wants, the luxuries, or caprices of society 
sustain, inhaling a mephitic or otherwise vitiated atmosphere, work- 
ing in distorted positions of body and limbs, and every energy strain- 
ed to earn a modicum of subsistence. 

Estimating this as it may be, it shrinks into insignificance, com- 
pared with an agency which is felt in our o%n country in all its force. 
The vast and unexampled consumption of ardent spirits by our peo- 
ple, the constant stimulation under which they are kept by it, and 
particularly as relates to the impetuous action given to the heart, we 

13* 



142 Diseases of the Heart. 

should presume, independently of positive evidence, that it must 
prove a prolific cause of cardiac derangement. But what might have 
been suspected, is conclusively demonstrated. Numerous instances 
of the consequences of such an abuse, we have met with in private 
practice, and so frequent are they in our Alms-house Infirmary, that 
capacious receptacle of drunkards, that we are rarely ever without 
them, and in those opened, of whatever disease they may have died, 
cardiac lesions are frequently observed. 

Not so pernicious as the preceding cause,'though undoubtedly con- 
ducive to the same result, is the habit of gluttony, or a too free indul- 
gence in stimulating food, operating by an oppressive plethora or un- 
due irritation of the heart, or depravation of the digestive functions 
which are prone to reflect their disturbances on the organs of the cir- 
culation. Directly the reverse of this, or a diet exceedingly low and 
penurious, has been .suspected to be also detrimental in this respect, 
by causing an atrophy of this organ, from inadequate supply of nu- 
triment 

By a distinguished authority, it has been suggested, that cardiac, 
in common with other diseases, have their periods of more frequent 
occurrence, owing to some peculiar constitution of the atmosphere. 
That they should be exempt from an epidemic influence, no reason 
can be assigned, though we have never witnessed any manifestations 
of it. Be this, however, as it may, they are certainly dependent on 
the sensible qualities of the weather, to be directly traced to that hu- 
mid and austere state, so productive of rheumatism and the pneumo- 
nic affections. The population of our eastern sea-board, during the 
more inclement seasons, are exceedingly liable to cardiac disorders, 
which once established, are very difficult of cure, except by a remo- 
val to a milder climate, several of whom have come to this city and 
recovered under our care. 

In much the larger number of instances thus induced, the affection 
is purely rheumatic, though undoubtedly, sometimes otherwise, the 
heart secondarily suffering from an antecedent disorder of the lungs, 
occasioning an obstruction to the circulation on the right side. The 
rheumatic attack may be immediately on the heart, or translated to 
it from a joint or any other external part of the body, the latter be- 
ing the more common occurrence. Exactly in the same way, does 
gout operate, either misplaced, or by metastasis, and we are entirely 
persuaded, that nearly thf whole of the cardiac affections of aged 
persons, are to be imputed to the weaker or atonic variety of that 
disease. 

As somewhat analogous, the repulsion of cutaneous eruptions may 



Diseases of the Heart. 143 

here be mentioned as a further cause, and to which, we are inclined 
to believe, that too little has been usually ascribed. But indepen- 
dently of the numerous cases reported by Testa and Kreysig to this 
purport, several have occurred in our own practice of the most con- 
clusive nature. The exanthemata, as measles, scarlatina, &c. we are 
told, sometimes thus operate mischievously, though deciding from 
our own experience, we should say, that it is more frequently to be 
traced to the recession of the chronic eruptions, and particularly to 
tetter, of which, we have recently seen two well marked instances. 

Much has, moreover, been imputed in the production of cardiac 
affections by Testa, to a strumous habit — and still more to syphilis, by 
Corvisart — the latter of whom, believes that the valves of the hedrt are 
very liable to become deranged by it. Distinct from the testimony of 
these authorities, there is no reason to question, a priori, such an effect, 
though we are assured by Bertin, whose experience was ample, that 
the influence of venereal contamination has been greatly exaggerated. 
To these more general causes may be added certain congenital dis- 
proportions between different parts of the heart, and between that 
organ and the diameter of the aorta, as pointed out and explained by 
Corvisart and Laennec. 

Most of the causes hitherto enumerated, act more immediately on 
the heart itself. But it is sometimes affected by impressions indirectly 
imparted from the sufferings of other organs. It has already been in- 
timated, that certain states of the lungs exert a material influence in 
this respect, and which is sufficiently intelligible without any expla- 
nation. Besides these, however, the heart may be injured by its sym- 
pathies with remoter parts. Chronic irritations of the primge viae, 
as we have hinted, are very apt to be extended to it, and enlarge- 
ments of the liver, pancreas, spleen, or any other of the abdominal 
viscera, are scarcely less injurious, by either transmitting their irri- 
tations, or obstructing the circulation, by compressing the large ves- 
sels in their vicinity, or in other modes. Even pregnancy may have 
this consequence. 

That diseases of the heart are often hereditary, is now conceded, 
though in what such predisposition consists, does not very clearly ap- 
pear. Congenital defects of the organ itself, or certain deformities of 
the chest, natural or acquired, from rickets or by other means, may 
have such an effect. 

But in some instances, it seems to exist independently of mal-con- 
formation or any obvious cause, and is wrapt in as much obscurity as 
is the predisposition to many other diseases. Be it as it may, the fact 
is fully established on the authority of Lancisi, Albertini, Mor- 



144 Diseases of the Heart. 

GAGNi, Portal, Testa, and other writers, by whom cases are relat- 
ed of its pervading whole families, and of different generations. 

With these preliminary remarks, we enter on the consideration of 
some of the individual affections of the heart, and first, of its acute 
phlogosis. Carditis, as this is technically called, we are told by La- 
ennec, is a very rare event, and of course imperfectly understood 
both in a pathological and practical view. '' There, perhaps, does 
not exist on record," says he, " a satisfactory case of a general in- 
flammation of the heart, either acute or chronic. The greater number 
of cases so called, and particularly those given by Corvisart, are evi- 
dently instances of pericarditis, attended by that degree of discolour- 
ation of the heart, which we shall find frequently to accompany that 
affection." 

It seems to us not at all probable, that such is a just view, as we 
can discern no reason why the substance of the heart should have this 
exemption from acute phlogosis — and certain it is, that it is liable to 
various lesions, the origin of which can scarcely be assigned to any 
other process than chronic inflammation. As, however, it is admitted 
that we are possessed of no means of discrimination between the 
phlogosed state of the organ itself, and its enveloping membranes, 
and even could it be done, the treatment were the same, we shall, 
in pursuance of Laennec's hypothesis, proceed to the consideration 
of Pericarditis. 

This is an affection not always distinctly characterized by symp- 
toms. Cases may be presented with the most unequivocal indications 
of it, when on a post mortem inspection, no traces of it can be dis- 
cerned — and, conversely, decided evidence of its having prevailed, 
where not the slightest cause existed to suspect it. The disease, La- 
ennec says, may be divined from certain symptoms, though not po- 
sitively recognised or determined. Corvisart is nearly of the same 
opinion. 

That this obscurity may occasionally prevail, we are bound to be- 
lieve, on such high and concurrent authority. But really, from our 
own observations, we must think, it is not a little exaggerated. 

In delivering the history of the disease, the prominent symptoms, 
as found in the best writers will be given, with such as we have re- 
marked ourselves, in the cases which have come under our notice. 
These are varied according to the nature of the attack — sometimes 
the invasion being gradual and mild, and, at other times, sudden and 
vehement. Generally, however, it is betrayed in the beginning, by 
pretty nearly the same signs as pleuritis. But soon it assumes a less 
equivocal aspect by a very acute pain, and sense of heat in the prae- 



Diseases of the Heart, 145 

cordial region, bj extreme difficulty in breathing, by inability to 
change the position, which is usually on the back, particularly to turn 
to the left side, or to straighten it, by much restlessness, anxiety, and 
apparent anguish, the face being pale or occasionally flushed on the left 
cheek, or tumid and saturnine, sometimes bedewed with perspira- 
tion, and by a frequent disposition to syncope. It often happens, and 
it is among the most characteristic of symptoms, that the recumbent 
posture cannot be at all endured, and relief is only afforded, by sitting 
up, either in or out of bed, with the trunk bent, and the arms resting 
on the back of a chair, or some other support. Compressing the heart, 
it will usually be found bounding and forcible, and the pulse strong, 
full and frequent — in this respect, however, differing — sometimes 
the contractions of the heart being feeble and irregular, and the pulse 
small, corded, intermittent, and, as it were, jerking or convulsive. 
It is said that there is sometimes a difference in the pulse of the two 
arms, that of the left being more quick and less regular than that of 
the right. The urine is high-coloured and scanty, and the bowels 
constipated. Towards the close, distortion of countenance takes place, 
marked particularly by protuberant, moist, and shining eyes, with 
increased jactitation, and an expression of terror or despair — and 
finally, lividity, cold sweats, and puffiness of the face. Complicated 
as this affection is often, by a more or less extensive inflammation of 
the lungs, or their connexions, the symptoms, of course, are consi- 
derably modified. It may also be proper to advert to that form of the 
disease dependent on rheumatism, which, however, when a primary af- 
fection, and not of extraordinary violence, we are not aware is to be 
distinguished by any peculiarities. But caused by a sudden and en- 
tire metastasis from the extremities, the heart is instantly seized with 
a sharp, lancinating, spasmodic pain, and is thrown into the most la- 
borious action, with great irregularity of the circulation, and throb- 
bing of the vessels of the neck. 

As to the etiology of this disease, it can hardly be required of us 
to particularize it after the general discussion which the subject has re- 
ceived. In most recent attacks, we presume, an exposure to cold, and 
moisture, is the main cause, heightened no doubt, in many instances, 
by intemperance. 

The diagnosis as we have seen, so far as depends on symptoms, is 
represented as very often obscure, and deserves little confidence. 
Corvisart supposes this ambiguity to be owing to pericarditis being 
complicated with pleuritis, peripneumony, paraphrenitis, mediasti- 
nitis, or some other disease of the chest, which masks its peculiar 
signs. Thus combined, the aspect of the case must necessarily be 



146 Diseases of the Heart. 

confused by extraneous incidents. But when of a simple character, 
we have experienced little perplexity in the recognition of it. Many 
of its phenomena are very peculiar and distinctive, and especially the 
expression of countenance. Corvisart in his discriminations, relied 
much on this morbid physiognomy, and is reported to have attained 
such skill in it, that he was rarely deceived in his decisions. The 
stethoscope supplies no very distinct information: all which we learn 
from it is, that in a person previously healthy, the contractions of the 
ventricles of the heart give a strong impulse, and sometimes a sound 
more marked than in the natural state: at intervals of various dura- 
tion, more feeble and shorter pulsations occur, corresponding to in- 
termissions of the pulse, of which the smallness is singularly contrast- 
ed with the force of the beatings of the heart: sometimes it can scarce- 
ly be felt. 

It must be obvious that this is a disease, under all circumstances, 
©f no ordinary danger. Emphatically a vital organ, the heart can 
Bever suffer with impunity to the living system. There are also inhe- 
rent difficulties to the cure of its affections. Most other organs may 
be placed in a state of rest so important, when crippled or disorder- 
ed. But the actions of the heart cannot be suspended for a moment — 
its labours are in fact increased, and it becomes an instrument of its 
own destruction, or tends to snrh an pffprt. This case, however, is 
not necessarily fatal, and may be, indeed, often relieved by vigorous 
measures, provided we are early consulted. The prognosis, on the 
whole, must be held to be very doubtful. Death sometimes happens 
very suddenly, when not at all foreseen or anticipated, owing to spasm 
of the heart, and which is most apt to occur in the arthritic and rheu- 
matic forms of the disease. We once attended a case where life was 
instantaneously extinguished by a translation of rheumatism to the 
heart, and several similar instances are recorded. 

On a post mortem inspection, the following appearances are pre- 
sented. The serous membrane is found inflamed, the redness always 
slight and partial, commonly punctated, or in points or patches, with 
an interspersion of specks of blood close together. It is very usual 
to meet with a concrete albuminous exudation investing the whole 
surface of the pericardium, as well on the heart and large vessels, as 
on the sac. This exudation, though resembling the false membrane 
in pleurisy, is thicker, more consistent, and rougher, sometimes so 
pustular in its aspect, as to have been mistaken for the variolous erup- 
tion.* No thickening of the tissue is perceivable. 

* Laennec, p. 264. \ -- - 



Diseases of the Heart. 147 

In the cavity of the pericardium, effusions are uniformly observa- 
ble, mostly of a pale yellow colour, or slightly brownish, in which are 
mixed fragments of semi-concrete albumen. The quantity of this 
fluid is considerable, often a pint, and in one case mentioned by Cor- 
visart, it amounted to two quarts. But instances occur in which it 
is altogether wanting, its place being supplied by concrete albumen^ 
filling up entirely the pericardial sac. It also happens, though very 
rarely, that a purulent secretion only exists, among the most remark- 
able examples of which, is one by Baillie, of a quart of pus, and an- 
other by Duncan, of two pints and six ounces in the pericardium.* 
These different products, serum, albupien, and pus, are referrible to 
the several gradations of violence in the inflammatory process in the 
respective cases. 

In the management of this disease, the indications are few and sim- 
ple, and the remedies equally so, though in the application of them, 
the utmost decision and vigour are demanded. As of primary im- 
portance, venesection should claim attention — and to be effectual, must 
be urged to great extent — the limits of which to be determined only by 
unequivocal evidence of relief. On this point we wish to be the 
more impressive, since occasionally such is the state of pulse, and dis- 
position to syncope, as might perhaps impose undue restraints on the 
practice. Cautions to this purport are moreover contained in most of 
the writers on the subject, well calculated to lead astray. As auxiliary 
to the general bleeding, leeches or cups ought next to be largely em- 
ployed, and repeated from time to time, till the force of the attack is 
overcome, when a blister may be resorted to efficaciously. An atten- 
tion to the bowels, further than merely to obviate constipation, is all 
which is exacted. During this period, if any irregular spasmodic ac- 
tion of the heart prevail, the appropriate remedy is opium by itself, 
or in the shape of Dover's powder. It cannot do harm, and we have 
seen much advantage from it, as well in this, as the serous inflamma- 
tions of the lungs, under similar circumstances. 

In the treatment the subsequent stages of the disease, great re- 
liance is placed on digitalis, and the seminal tincture of colchicum, 
separately, or combined, and for the purpose either of quieting vas- 
cular irritation, or the promotion of absorption of the effused fluids 
in the pericardial cavity, are undoubtedly among the very best 
means, especially the first mentioned article, which we know to be 
eminently serviceable. More, perhaps, than any other medicine, 
does digitalis controul the circulation, and to this property chiefly, 

* Reeder, p. 28. 



148 Diseases of the 'Heart. 

are its beneficial tendencies to be ascribed in, perhaps, all diseases. 
Granting this, which we think cannot well be denied, it follows, that 
it should be peculiarly adapted to the cardiac disturbances, and what 
thus seems plausible in speculation, has been amply confirmed on 
trial. It ought not, however, to be concealed, that in some instances, 
opium, calomel, and ipecacuanha, in small portions, prove even more 
effectual, though on the whole, less entitled to confidence. 

Concerning those cases, evidently dependent on gout or rheuma- 
tism, by metastasis, or otherwise, the course of proceeding is essen- 
tially the same. It may suflice, at present, merely to mention, that 
a leading object, more especially where a translation has happened, 
is to endeavour to invite back the disease to the original position, or 
the lower extremities, and which is to be done by stimulating pedi- 
luvia, sinapisms, and other irritating applications. 

Chronic Pericarditis. — In most respects this has so close an ana- 
logy to the acute form of the disease, that it may be rapidly despatched. 
The symptoms are essentially the same, though when in an original 
state, milder, and its whole career is characterized by less rapidity 
and vehemence. It is usually attended by some febrile movement, a 
small, quick, corded, irritated pulse, which is sometimes vibratory, 
or even intermittent. The hand being placed over the heart, a jar- 
ring sensation may in some instances be felt. There is, however, 
seldom any palpitation, and never to any extent, though a sort of 
pulsatory sensation is often experienced in the epigastrium. Little 
or no pain is complained of in the region of the heart itself, and that 
little, when it does occur, is rather obtuse than acute, and is fugitive 
or unfixed. But sharp, and more permanent pain, is found in some 
portion of the abdomen, most frequently in the epigastric or hypo- 
gastric region — and when in the latter, produces, oris associated with, 
suppression of urine. This pain in the advanced stage, is sometimes 
so severe, as to be compared to the throbbing of an inflamed tumour. 
The stomach, as well as the head, occasionally suffers, the one being 
exceedingly irritable, and the other aching, giddy, or confused. 
Continuing for an indefinite period, months or years, the case pro- 
gressively assumes a worse aspect, the countenance becomes pallid 
and doughy, the difficulty of respiration increases, even to dyspnoea, 
particularly on any exertion, or in a recumbent posture — oedema of 
the extremities appears, first of the left side, and then more general 
bloating, and if death does not abruptly happen, it ensues from ema- 
ciation and exhaustion. This is the portraiture of the disease as in- 
duced by ordinary causes. But when dependent on arthritic or rheu- 
matic influence, it varies considerably. The pain in the heart is far 



Diseases of the Heart. - 149 

more acute, greater anxiety and oppression at the preecordia are com- 
plained of, the palpitations are often so violent as even sometimes to 
be heard,* attended by strong pulsations of the carotids, the pulse 
more disturbed, and the respiration so affected, particularly by the 
recumbent position, or by any exertion, that the extinguishment of 
life seems to be menaced. The case, moreover, is distinctly pa- 
roxysmal, and controlled manifestly by states of weather. 

In regard to the causes of this affection, they will be found to be very 
much the same as of acute pericarditis. But, perhaps, it is oftener of 
a rheumatic nature, which we are the more inclined to suspect, from 
the number of cases that have come under our notice in corroboration 
of the fact. 

Embarrassing as is the diagnosis in the acute, even more so, is it 
frequently in the chronic form of the disease. The highest authorities 
confess, that there are no features of discrimination, implicitly to be 
trusted. Cases have occurred to them all, in which they were utterly 
deceived, and we presume, no candid practitioner who has had ex- 
perience, will hold any other language. Laennec expressly says, that 
he has frequently found the pericardium full of pus, and in a true 
state of chronic inflammation, without ever having suspected it, and 
conversely, has seen it sound, when imagined to have been seriously 
affected. The external means of exploration shed no clearer light on 
the case. Notwithstanding this occasional obscurity of diagnosis, we 
must still think, that in a large proportion of instances, a careful in- 
vestigation will conduct us to a correct inference. 

Tliat this is a disease of rare and difficult cure, it need scarcely be 
remarked, though not so intractable as to discourage our exertions. 
Of course, much depends on the stage of the case, and the degree of 
structural injury sustained. Even, however, where the organic lesions 
are considerable, recoveries do undoubtedly sometimes take place. 
Effusions into the pericardium are certainly removed, and often we 
meet with the firmest adhesions of that membrane to the heart where 
no inconvemence had been felt during life.t Corvisart, we are aware 
asserts that no person can live, and preserve a good state of health 
with such adhesions, which, however, is positively contradicted by La- 
ennec, who has seen the contrary frequently, and the same is corro- 
borated by our own experience. 

In chronic pericarditis, may be detected usually, the morbid phe- 
nomena which we are now to describe. The phlogosis of the serous 
tissue is more extensive, and of a deeper red, than in the acute dis- 

* Dimdas, Med. Chir. Jour. Vol. I. | Laennec, p. 265. 

Noi XI.— May, 1830. 14 



150 Diseases of the Heart. 

ease, and, the adventitious membranous exudation, is of much rarer 
occurrence, and when it does exist, is thin, soft, friable, resembling 
a layer of very thick pus. Effusions are always to be met with in the 
pericardial cavity, of a turbid milky fluid, sometimes of a puriform 
character, and in considerable quantities. The muscular substance 
of the heart itself undergoes a change in some instances, losing its co- 
lour, and becoming whitish, as if macerated for several days, sometimes 
with a retention of its natural consistence, though as often considerably 
softer. By most writers these alterations have been ascribed to inflam- 
mation, which is denied by Laennec, who alleges, that the only proof 
of the existence of that process in a muscular organ, is a deposition 
of pus among its fibres. But whatever may be the correctness of his 
opinion in the main, surely he is wrong in the latter assertion. That 
muscles may be phlogosed, without suppuration, we habitually see, 
from wounds, rheumatism, and other causes. Entertaining a great 
aversion to Broussais, he diff'ers from him whenever he well can, and 
was probably seduced into this error by a spirit of opposition, the one 
looking to inflammation as the source of nearly all morbid appear- 
ances, and the other as constantly rejecting it from his system of 
causation. 

In determining on the treatment of this disease, we should be regu- 
lated very much by the stage of the case. Being far advanced, and 
the organization of the heart deeply impaired, our efforts must ne- 
cessarily be limited to mere palliation of urgent affections. But un- 
der different circumstances, or where a hope of cure is entertained, 
another course is to be pursued. 

As preliminary to every thing else, let a state of as much mental 
quietude, and bodily rest, as is attainable, and a diet of the smallest 
bulk, and the least nutritive and stimulating quality, be imposed, and 
most scrupulously observed. Lately it has been said, on the autho- 
rity of Broussais, that asparagus has an exceedingly sedative quality, 
controlling in a remarkable degree, the moving powers of the circu- 
lation, without irritating the stomach,* which if found to be true, it 
will be a very appropriate article of food in these cases. It is steadily 
to be borne in mind, that the great purpose is to exonerate the heart, 
as far as practicable, from the labours of its office, and which will be 
best effected by the reduction of blood, by abstinence, and the care- 
ful avoidance of all extraneous irritations and excitements. Co-ope- 
rating in the same design, those remedies which are calculated to sub- 
due cardiac and vascular action, or relieve topical uneasiness, are to 

* See last Number of this Journal, pag-e 499. 



Diseases of the Heart. 151 

be brought into requisition. Need we state that these consist in gene- 
ral and local bleeding, with vesication over the seat of the affection. 
But where cups or leeches can readily be had, venesection for the 
most part, may be superseded. 

Nearly the same medicines are used here as in the acute dis- 
ease, though we think, with decidedly superior advantage. The 
seminal tincture of colchicum is serviceable, the digitalis still more 
so, and a combination of opium and calomel should always be tried 
in unrelenting cases. It is highly extolled by the English practi- 
tioners, would seem to be suitable on general principles, and we have 
seen it serviceable, or we are much deceived. But in prescribing 
mercury, it should be very cautiously introduced, so as to escape all 
inordinate effects, and with this view, not m.ore than half a grain, 
ought to be given, two or three times a day. 

By undeviatingly pursuing this plan, for a length of time, we shall 
undoubtedly in some instances arrest the disease, and accomplish a 
complete cure. We have known it to succeed in several cases, and 
can, therefore, confidently recommend its adoption. That, however, 
justice may be done to it, all the parts should be made to concur, 
and it must not be too hastily abandoned in despair. Let the regimen 
correspond with the remedies, all harmoniously tending to the same 
end, and slight as the improvement may seem, receive it as adequate 
encouragement to further and unremitting exertion. It is well remark- 
ed by BoERHAAVE, that chronic diseases require a chronic treatment, 
and that an experiment of any course, cannot be considered as fairly 
made in less than three months. Not to adopt literally this senti- 
ment, there may be deduced from it an admonition against precipi- 
tate fluctuations in practice, and a salutary lesson to diligence and 
perseverance, in the management of lingering and indomitable cases. 
There is one other precept of great importance, in relation to the ma- 
nagement of this disease. Being of a rheumatic nature, which there is 
so much reason to suppose is often the fact, and according to our 
own observations, particularly in young persons, it is highly expedi- 
ent to have the patient removed from an austere, to some genial cli- 
mate. Equally benignant is such an influence over these cardiac, as the 
pulmonary affections. Cases which had proved utterly intractable, 
we have known to do well under precisely the same treatment, by a 
change to a more favourable residence. 

As the occasional result of the preceding disease, we might Here in- 
troduce some remarks on hydrops pericardii. But since this cannot be 
done advantageously without an examination of the general patho- 
logy of dropsy, which would lead us into a discussion very wide from 



1 52 Diseases of the Heart 

our present purpose, we shall pass over the subject, and applj the 
residue of our space to the consideration of what may be properly 
viewed as the organic affections of the heart. 

These have been recently multiplied to an inconceivable extent by 
a minuteness of division, which, however curious to the mere culti- 
vator of morbid anatomj'', serve rather to perplex, than to guide us 
more luminously in actual practice. Even admitting that these nu- 
merous, and infinitely modified affections, are susceptible of a pre- 
cise recognition, it would not materially influence the treatment, one 
common plan being applicable to a large portion of them, and the 
rest, with some limited exceptions, are utterly irremediable. It is 
our intention to select out of this complicated mass, or assemblage 
of diseases, such only as we have the power of relieving, and must 
refer for further and more comprehensive intelligence of the subject, 
to some of the elaborate treatises on it which have lately issued from 
the press. But it may be useful, though not enabled to discriminate 
the nicer shades of cardiac affections, to have it in our power to dis- 
tinguish them from other diseases, and happily, most of the organic 
lesions of the heart have so much of a commonalty of phenomena or 
signs, that the attainment is greatly facilitated. Cardiac disorganiza- 
tion of some sortmaybestronglysuspected, if not accurately determin- 
ed, whenever there is a concurrence of the symptoms that we are now 
lo enumerate. Being very expressive of such a condition, it may 
be stated, that the countenance is singularly bloated, with occasion- 
ally an intermixture of a purple hue, extending to the lips, which 
are sometimes exceedingly protuberant or tumid. Exceptions, how- 
ever, often exist to this lividness of complexion, the face remaining 
throughout of a waxy palor, with oedematous swelling, particularly of 
the eyelids, and adjacent integuments. This condition, at first limit- 
ed, becomes ultimately far more general, or may pervade the entire 
superficies — and the cutaneous veins throughout, are turgescent and 
distended. Connected with this, there are also m the advanced stage, 
effusions from the serous tissues of the internal cavities, constituting 
universal dropsy. 

The respiration is habitually short and difficult, invariably aggra- 
vated by quick walking, ascending an height, or any other exertion, 
and by the indulgence of passion, or mental emotions generally. Not 
a little may also be learnt from the state of the digestive process. It 
is almost uniformly disordered, and, in some instances, reaches the 
highest degree of exasperated dyspepsia, with torpor of the bowels. 
As an effect, perhaps, of this gastric irritation, the temper and mind 
are considerably affected, denoted by petulance, melancholy, and 



Diseases of the Heart. 153 

even despair, becoming occasionally ^o intense, that we are told bj 
some writers, suicide very commonly results from this distempera- 
tare.* It is, however, more from the state of the circulation, than 
any other function, that information is to be collected. The action 
of the heart is commonly, though not uniformly irregular, betrayed 
chiefly by palpitations, sometimes extremely violent, especially when 
under excitement, and at other times, not exceeding a moderate vi- 
bration. Equally various is the pulse, in some instances very strong, 
jerking, or intermittent, while on other occasions, it is weak, tremu- 
lous, or nearly imperceptible. By an application of the hand, how- 
ever, over the heart, we shall generally discover that its dilatations 
and contractions are different from those of health, influenced of 
course by the nature of the lesion. Thus, in dilatations in general, 
the strokes of the heart are usually felt in a wide space, embracing 
much of the thorax, and extending even to the epigastrium, so as to 
be misapprehended for pulsations of the coeliac artery. In active 
aneurisms, as they are called by Corvisart, the strokes are frequent, 
regular, vibrating, and so vigorous, as that the hand placed over the 
heart receives a blow, and is made to rebound, while in the passive 
dilatations, these strokes are softer, slower, and equally regular in 
the interval of their return. The valves being contracted by ossifica- 
tion, or other causes, the strokes are intermittent, sometimes powerful 
for a moment, more frequently weak, with a sensation of rushing like 
water, or of undulation, or trembling, &c. When there is a degene- 
ration of the fleshy substance of the organ into fat or bone, a soften- 
ing of its fibres also takes place, and its strokes are slow, feeble, and 
may be almost insensible.t Nor is the venous circulation without 
some indications which demand attention. To an engorged state of 
the superficial veins we have before alluded, and may now remark, 
that in the larger ones, as the jugular particularly, there is a decided 
pulsation, frequently mistaken for that of the carotids, and evidently 
a confused tumultuous circulation in them, owing to the difficulty the 
blood encounters in returning to the heart. It is for this reason that 
heavy engorgements take place in the different organs, and conse- 
quent haemorrhages, more especially from the lungs, the liver, and 
nostrils. But much as may be acquired by a careful survey of these 
several sources of intelligence, they will all, in many cases, either 
prove inadequate, or betray us into false conclusions, and it is to the 
new methods of investigation, by percussion and the stethoscope, that 

* Testa and Kreysi^. f Corvisart, p. 283. 

14* 



1 54 Diseases of the Heart, 

we are to look for any certainty. Even these means, as is candidly 
acknowledged by Laennec himself, in their application to the diseases 
of the heart, are liable to considerable fallacy, and that great skill, 
and much circumspection, are demanded in their use.* 

Concerning the remote causes of the cardiac affections, we have al- 
ready disposed of this part of the subject. Notwithstanding what is 
affirmed to the contrary by some, we are persuaded that most of these 
unite in the production of inflammation, either acute or chronic, and 
to the ordinary consequence of this process, are the organic lesions 
of the heart chiefly to be referred. Yet some of them seem to occur 
independently of it, or at least without its ordinary manifestations, 
and in such cases, consisting in new formations of structure, a vitia- 
tion of the nutritive functions, has probably taken place in some other 
way. As this may not be very clearly understood, we will endeavour 
to render it intelligible by a few words of explanation. It must be 
known, that in a perfectly sound state, as absorption removes the old 
matter, it is replaced by. new acquisitions of precisely a similar cha- 
racter, moulded into a like shape, whereby an absolute identity of 
substance, as well as figure and size, are preserved. The processes 
of destruction and renovation are perpetually going on in the living 
state. Like the vessel of the Argonauts, which, in its tedious and 
perilous voyage, w^as so often repaired, that, on its return, no vestige 
of its original frame remained, so, in the progress of time, every part 
of our material composition is removed and renewed. To the steady, 
undeviating performance of this office are we indebted for the inte- 
grity and uniformity of our fabric in all its parts. Nutrition, however, 
becoming distempered, it no longer operates in this established order, 
and its products are correspondently aff*ected. The nutritive is only 
the secretory function on an extensive scale, and as the latter, so is 
the former disturbed by morbid agencies. Granting the fact, that 
the one set of vessels do secrete, under certain influences, every va- 
riety of matter, from a simple serous fluid, to the most virulent poi- 
son, we can have no difficulty in conceiving how another description 
of them when deranged, may pour out all those various ingredients 
which enter into the formation of diseased structure. It is by such 
interstitial deposition of extraneous matter, that the character of the 
heart, or other organs, is altered, which, being heaped on, without 
the plastic hand of nature to model it, they are made to exchange 
their definite configurations and dimensions, for the rude and anoma- 
lous shapes occasionally exhibited. 

* Laennec, p. 598. 



Diseases of the Heart. 155 

As one of the most curable of these affections, we shall commence 
with hypertrophia of the heart. By this term, according to its etymo- 
logy, is to be understood an excess of nutrition, and as applied to the 
present case, an increase of the muscular substance of the organs by 
which its parietes become much thickened, in some instances, to an 
inch or more, with a vast augmentation of its general dimensions. 

Its existence is denoted when in the left ventricle, by a very strong 
impulse between the cartilages of the fifth and seventh ribs, to which 
space the pulsations are circumscribed, and here the sound of percus- 
sion is dull. The impulse of the ventricle is considerably lengthen- 
ed, where the hypertrophy is excessive, while the contraction of the 
auricle is correspondently short, and examined in the preecordial re- 
gion, its sound is scarcely perceptible, though at the superior part of 
the sternum, and under the clavicle, it is loud and distinct, whereas 
the stroke of the ventricle is scarcely to be recognised in these posi- 
tions. The pulse is usually vigorous and full, and the face contrary 
to what commonly happens in cardiac affections, has a red tinge. The 
hypertrophy being in the right ventricle, the stroke is stronger than 
natural — is perceived more plainly at the bottom of the sternum 
than between the fifth and seventh ribs, and on the right than left 
side of the chest: — -and it is in this position that the resonance is dull 
on percussion. But when it exists in both ventricles, the signs of course 
of each are found, those of the right generally predominating. 

As the main cause of this undue growth of the heart, all diseases 
which induce permanent dyspnoea are assigned, by which this organ 
is constantly excited to increased efforts to propel the blood through 
the lungs, and it is in the same way, that violent exercise of any kind 
habitually taken, may operate to a similar effect. No fact is better 
established than that any, or every muscle inordinately used, becomes 
larger, and hence it is that those of the arm in the pugilist, of the 
shoulder in the porter, and of the leg of the opera dancer, have such 
immense developments. But conceding this, we are still inclined to 
suspect rheumatism as the most frequent and direct cause. 

The anatomical characters of these affections correspond to the nature 
of each. When the left ventricle is the seat of the lesion, its walls and 
the base acquire an increase of thickness and density, gradually di- 
minishing towards its apex. But in the right ventricle there is less 
of these changes, and the thickness is uniform throughout, except^ 
perhaps, towards the tricuspid valves, and origin of the pulmonary 
artery. The cavity of neither ventricle is enlarged: on the contrary, 
very much reduced, agreeably to the statements of Laennec, in which 



156 Diseases of the Heart, 

respect, he differs from Corvisart, who asserts directly the reverse as 
the fact. But he is wrong, or at least our own dissections do not 
support him. Cutting into the muscular substance of the heart, it is 
found more firm and deeply coloured than naturally. 

Next we are to consider the dilatation of the ventricles, entitled 
by Corvisart passive aneurism. It consists of an expansion of the 
cavities of the ventricles, with a proportionate diminution of their 
parietes. The indications of it, when in the left ventricle, are, the con- 
tractions of the heart giving a clear and loud sound between the fifth 
and seventh ribs, graduated to the extent of the injury, and if in the 
right ventricle, their resonance is to be heard more distinctly at the 
inferior portion of the sternum. The pulse is commonly soft and 
feeble, and the palpitations very slight. On pressing the cardiac re- 
gion, the heart feels as if a soft body elevated the ribs, and did not 
strike these, with a sharp and distinct impulse.* It is here particular- 
ly that the veins of tlie neck are swollen, and the countenance of a 
purple hue.t 

Bertin, one of the latest and best writers on the subject, is of opi- 
nion that this affection is always occasioned by some obstacle to the 
course of the blood, such as ossification of the valves, congenital nar- 
rowness of the aorta and pulmonary artery, the influence of certain 
employments which induce laborious efforts, and finally diseases of 
the lungs. But Laennec, while admitting these agencies, ascribes 
still more to original disproportions in the several portions of the me- 
chanism of the heart itself. | 

The appearances on dissection may be conjectured, from what 
has been said in the definition of the disease. The capacity of the 
ventricles is found to be augmented, and the thickness of their 
walls proportionally diminished, especially at the point of the left 
ventricle. But the dilatation is sometimes partial, being confined to 
a single part, and the substance of the heart is more or less deeply 
red. 

The two states, however, of hypertrophy and dilatation, are occa- 
sionally blended in the same case, constituting the active aneurism 
of Corvisart. This compound affection is indeed more common than 
simple dilatation, and still more so than hypertrophy singly. It is 
under these circumstances of complication, that the heart attains to 
an enormous size, sometimes triple that of its natural dimensions. 

Its most distinctive signs are a mixture of those of the elementary 

* Corvisart. f Martinet, p. 200. i Laennec, p. 593. 



Diseases of the Heart. 157 

states of which it is composed. The contractions of the ventricles 
yield at the same time a strong impulse, and a very marked sound, 
and those of the auricles are also very sonorous. The stroke of the 
heart may be heard over a wide range of the chest, in thin persons 
particularly, below the clavicles, on the sides, and even towards the 
back. To the hand, the contractions of the ventricles are very per- 
ceptible, which is raised by the sharp, definite, and violent pulsations, 
and sometimes such is the vehemence of the action, that the head, 
limbs, and bed-clothes are obviously shaken. The general circula- 
tion is much disturbed, the pulse strong, hard, vibratory, and resist- 
ing, and the pulsations of the carotid, radial, and other superficial ar- 
teries, are frequently visible. But instead of the ventricles, it some- 
times happens that the auricles are implicated in the hypertrophy, 
'which, however, is comparatively a rare event. It is said to be dis- 
tinguishable by the contraction of the auricle emitting a dull sound, 
in place of the clear one of health. But it seems to be allowed that 
from the rarity of the occurrence, it is not well understood, or its in- 
dications accurately ascertained. 

We turn to another set of affections, the indurations and concre- 
tions of the valves of the heart. In the very commencement of these 
derangements, there is habitual dyspnoea, increased by exercise, to- 
gether with palpitations, and when they become considerable, they 
may be known by the following signs: — The lesion being in theauricu- 
lo-ventricular openings, there is heard during the contraction of the 
auricles, which is then prolonged beyond its usual duration, a slight 
"bruit de rape," sound of the file, or a ''bruit de soufflet," sound 
of a bellows. These phenomena are constant, the former depending 
on an osseous induration of the valves, and the latter on a cartilagin- 
ous or fibro-cartilaginous state. When the contraction is seated in 
the arterial openings, aortic and pulmonary, the sound is synchronous 
with the pulse, and contraction of the ventricles: if the left orifices, 
(the mitral valves, and the sigmoid valves of the aorta,) are concern- 
ed, the " bruit de rape, or de soufflet,"'^ is heard between the cartilages 
of the fifth and seventh ribs of the left side, while, if it occupies the 
orifices at the right side of the heart, (the tricuspid valves, and the 
sigmoid of the pulmonary artery,) the sound is most distinct at the 
lower part of the sternum. This murmuring or thrilling is in 
some instances, sensible to the hand placed over the heart, especially 
when the mitral valve is ossified, and the contraction of the left auri- 
culo-ventricular opening is considerable. 

In all these cases, the palpitations are frequent — the strokes of the 



1 58 Diseases of the Heart. 

heart generally intermittent, unequal, and sometimes very strong, 
while the pulse is small and concentrated, the face is of a violet co- 
lour, the limbs oedematous, and the dyspnoea to which we have al- 
luded, progressively increases, till it proves fatal. 

An inspection after death shows very considerable alterations in 
the valves of the heart. Their natural form is lost — they becoming coil- 
ed upon themselves in such a way as to contract the aperture over 
which they are placed, sometimes to a very small size. They also 
lose their primitive cliaracter, and are converted into fibro-cartilage, 
cartilage, or even bone, a part, or the whole, undergoing this change. 
These degenerations are most apt to occur in the tricuspid valves, or 
the sigmoid of the pulmonary artery. 

In the valves of the left cavities, what are termed vegetations, are 
mostly to be met with, a sort of verrucse or warty excrescences, of va- 
rious forms and sizes, which interpose impediments to the closing of 
the valves, and as intimated, are generally to be found in the aortic 
or mitral valves. 

To the affections of which we have given some account, many 
others might be added. Enough, however, has been said on the sub- 
ject, to convey an impression of its complication and difficulties, and 
of the utter impracticability of doing justice to it in any narrow 
compass. Though we may not have succeeded, in clearing up its ob- 
scurities, some general information has probably been imparted, to 
awaken curiosity, to the further study, and more precise investigation, 
of this very interesting part of pathology. The publications regard- 
ing it are ample, and those by Corvisart, Burns, and Laennec, are of 
easy access, which, we hope, may be attentively perused, and deeply 
meditated. 

It is fortunate, amidst this contrariety of morbid condition, that 
one and the same plan of treatment is applicable to nearly the whole 
of^lhe varieties which may be presented. The leading principle, 
without the observance of which, every endeavour is frustrated and 
rendered nugatory, is to relieve the heart, as far as possible, of the 
labours of its office. To employ fully a diseased organ, is to increase 
its disease, and not more absurd would it be, to drive on a shattered 
piece of machinery, instead of checking it for the purpose of repair, 
than to force the heart, when thus crippled by its lesions. But the 
efforts of this organ cannot be spared during life, and it is reserved 
for us only to ease, or diminish, what may not be entirely suspend- 
ed. Conformably to this practical precept, the indications are, to re- 
duce the quantity of the circulating fluids, to avoid all irritants, and 



Diseases of the Heart. 159 

to maintain the utmost tranquillity and repose. As the most impor- 
tant of remedial measures, the loss of blood claims first to be noticed, 
and where the call is urgent, venesection should be preferred. But 
the circulation having been adequately emptied, and there is rather 
topical congestion, or excitement, than general vascular action, local 
bleeding may be very advantageously substituted. Concurring in this 
view, some of the sedative articles, or such as are calculated to calm 
irritation, and lessen the activity of the pulse, are not destitute of 
utility, among which, the digitalis deserves the greatest confidence, 
though the seminal tincture of colchicum, and the prussic acid, cau- 
tiously administered, are much prescribed. Nor are blisters, or se- 
tons, or issues, over the cardiac region to be neglected, as part of 
this plan. As material to the design, the diet must be duly regulat- 
ed, as well as to quantity as quality, very little food being allowed, 
and that little, the least nutritious, and of the mildest description, 
devoid of all heating and stimulating tendencies. No less is it de- 
manded carefully to guard against the pulmonary affections, which 
through the disturbance of the lungs, particularly agitate the heart — 
and since corporeal exercises, and mental emotions, have a similar 
effect, these are strictly to be restrained. 

By such a course of management, we will not promise, that cures 
are to be accomplished with any certainty. The result must depend 
on the kind, and the degree of the lesion, some being utterly intract- 
able where the change of structure is essential, or the case far ad- 
vanced. But as these are points not readily decided, it is our duty 
to make the experiment, whenever there is, from the circumstances 
of the case, encouragement to it, and more especially, since, though 
it may not completely succeed, it affords the exclusive means of pal- 
liation and comfort. Many are the instances, in which, otherwise, 
life would be speedily lost, or wretchedly endured for a season, it has 
been protracted for a very lengthened period, and with comparative 
ease and relief. But, sometimes, we are rewarded with more dis- 
tinguished success, and especially in hypertrophia, with or without 
dilatation, the most medicable of all these affections. In two in- 
stances, we have seen the heart of considerable dimensions reduced, 
and so many similar examples are on record, that the disease, no 
longer enumerated among the opprobria medicorum, is encountered 
with some confidence of overcoming it. As it arises from excess of nu- 
trition, it is obvious, that the treatment we have suggested, so far as 
relates to the direct reduction of blood, and the withholding the sup- 
plies of nutriment, is to be carried to the utmost extreme, and perse- 



160 Diseases of the Heart. 

veringly continued for months, and sometimes even for years. This 
is a matter about which no difference of opinion prevails, all the best 
authorities coinciding in recommending the practice, and holding out 
hopes of occcasional cures from a steady and resolute persistance 
in it. Nor ought vi^e in despair to abandon the case, merely on ac- 
count of its long standing, or manifestations of general or constitu- 
tional disorder. Even here, though there is less to be expected, some- 
thing may be accomplished, if not entirely to relieve, to mitigate suf- 
fering, and protract existence. It usually happens, in the progress 
of this disease, that to the enormous organic growth of the heart, cer- 
tain degenerations are added, among which hydropic effusions, with 
the general aspect of cachexy, most frequently are presented. Ex- 
actly such a case has been under our care for the last ten years, and 
by vigilance, and incessant attention, a fatal issue has been prevent- 
ed, and at this very moment, there is a greater probability of reco- 
very, than at any antecedent period. The heart is restored to nearly 
the natural size, all eflfusion has been removed, respiration is easy, 
the skin is resuming its floridness, digestion is tolerably well per- 
formed, and there is sufficient muscular strength, for the purposes of 
exercise on foot. To what is this amendment to be referred ? Ex- 
actly the course was pursued in the early stage which we have pro- 
posed, and after the dropsical, and other cachectic phenomena ap- 
peared, purgatives and the diuretics were resorted to, still strictly ad- 
hering throughout to the same description of regimen, as we have so 
strenuously inculcated. 



BIBLIOGRAPHICAL NOTICES. 

Art. XI. Beitrcige zur genaueren Kenntniss und Unterscheidung der Kehlkopfs- 
iind Luftr'dhren Schioindsuchten. Von Wilhelm Sachse, Grossherzoglich 
Mecklenburg-Schwerinschem Leibarzte und Medicinal-Rathe. Mit Kupfern, 
Hannover, 1821. 

Considerations relative to the Diagnosis of Laryngeal and Tracheal Phthisis. By 
William Sachse, &c. 

*' Hinc morbi exempla raro prescripta leg-untur illiusque naturam accuratius 
indag-are medicorum eo majis erit officium, quo plures hoc morbo miserime 
perisse constat," are the observations of the celebrated Thomann, (Annale, 
Tom. I. p. 165,) relative to the disease which has given origin to the work, the 
title of which we have just announced. If then this is the importance of the 
subject, we hope we may be excused in calling- the attention of our readers to 
the efforts made by Dr. Sachse, to establish the diagnosis between laryngeal and 
tracheal phthisis. These diseases have, doubtless, constituted at all periods of 
the world, part of the afflictions to which mankind are subject, yet notwith- 
standing the numerous treatises on consumption, but little attention has 
been directed to the form of the disease with which we are at present con- 
cerned. It is true that we find, even at an early period, occasional references 
made to this affection of the larynx and trachea, yet it is only in modern times 
that any very successful efforts have been made to elucidate its pathology. 
Amongst these attempts, that of Dr. Sachse should be particularly noticed, as 
it contains a more full and comprehensive exposition of the general characters 
and diagnosis of the disease, than any treatise on the subject with which we are 
acquainted. 

The author treats first, of the general characters of laryngeal phthisis; second, 
of tracheal phthisis; and third, of the diagnosis of these two aflections, as well 
as the difference between them and pulmonary consumption, and some other 
maladies with which they are liable to be confounded. 

I. Lakxngeal Phthisis. 

Young subjects are by no means so liable to this affection as the middle aged; 
the period comprised between the thirtieth and fiftieth year, being that which 
is most, obnoxious to it. In a case observed by Percival, it took place as late 
even as the sixty-third year. The author thinks that the inflammation of the 
larynx seldom reaches the ulcerative point in children, because in consequence 
of the greater susceptibility of their constitutions, the patient is destroyed long 
before the disease reaches that point. In this sentiment, however, we cannot 
entirely concur, since numerous cases have occurred, in which ulcers of consi- 
derable extent have been found in the larynx of children who had died of chro- 
nic croup. This latter affection may, indeed, be considered as one of the pre- 
disposing causes of this form of consumption, as must also the angina maligna, 
which has been observed by Huxham, when long-continued, to terminate in 
consumption. Amongst the causes of laryngeal phthisis, must also be enume- 

No. XL— May, 1830. 15 



162 Bibliographical Notices. 

rated the scrofulous and venereal virus, the influence of sex, Sec. I. Frank, 
who had frequent opportunities of witnessing- the disease, as well at Vienna, as 
at Wilna, considered it as peculiar to the male. The observations, however, of 
Thomann, Albers, P. Frank, Home, Sachse, and others, prove that it also at- 
tacks females. It is stated by the author that — 

'*It generall)'^ selects those who possess a very sensible skin, who are liable 
to erysipelatous and herpetic eruptions, and to superficial ulcerations about the 
neck." 

*' More or less hoarseness is usually the first symptom of the disease. It is 
generally considered, however, as merely the consequence of a common cold, 
and is consequently neglected; a conclusion in which the individual is often 
confirmed by the circumstance that the catarrhal symptoms are often relieved, 
or aggravated by the changes of weather. In a short time the patient com- 
plains of a slight uneasiness about the throat, which soon becomes changed into 
considerable pain, at first shifting, but afterwards fixed. This circumstance will 
at once prove that the case is not one of common catarrh. 

*' At an early period, there is an inconsiderable cough of the ordinary catar- 
rhal character, which, however, as the pain increases, becomes more violent, 
shrill, sonorous, or even stridulous, as in croup: every attempt to take food or 
drink, especially a sudden effort to swallow fluids, exposure to the slightest 
smoke or exhalation, or a current of air, or even an inspiration of cold air, ex- 
poses the patient to a kind of spasmodic cough. 

*' There is at first no expectoration, or it consists merely of a frothy mucus, 
streaked with blood. Sooner or later, according to the progress of the malady, 
it becomes consistent, puriform, very offensive, and of a grayish-yellow colour. 
It is, nevertheless, small in quantity, and is generally brought up with much 
effort, especially in the morning. During the greater part of the day, it remains 
frothy, and is at times mixed with a considerable quantity of saliva, in which the 
particles of pus sink to the bottom of the vessel. In some cases, fragments of 
pseudo-membrane are brought up by a considerable effort, portions of carti- 
lage; and it has been alleged that even one of the entire cartilages of the larynx 
has been discharged, having been detached by ulceration. 

" At an advanced stage of the disease, the breath of the patient acquires 
an offensive odour, which, as the malady advances, becomes so insupport- 
able, as to compel those who are exposed to it, to turn away their faces in- 
voluntarily. The respiration is generally free, and the motions of the chest for 
the most part unrestrained, yet the respiratory effort is occasionally interrupted. 
The patient feels as though the closure of the larynx interrupts the ingress of 
air; and this condition gives rise at first to a slight croupal wheezing, which, at 
a subsequent period becomes stronger and more sonorous. 

*' The voice is always hoarse, and finally becomes so feeble that it is withdif* 
ficulty the patient can be undel-stood. Indeed, in the morning, it is sometimes 
entirely extinct, and is only regained after the use of some warm drink. The 
pain is usually referred by the patient to some particular part of the larynx, be- 
ing seldom diffused throughout the whole extent of that tube, but sometimes 
extending to the trachea or the root of the tongue, and keeping up a constant 
burning sensation in the throat; the pain is generally worst at night, and is 
increased by pressure, by every attempt to swallow, and by the cough. It is 
also exasperated by any sudden motion of the head, or by the act of speaking. 

" As the disease progresses, deglutition becomes exceedingly difficult, so 
that finally the patient can scarcely swallow fluids, and is obliged to use such 
articles of diet as possess more consistence. Whenever he attempts to drink, 
a drop of water, by falling into the larynx, occasions such a violent spasmodic 
action of the parts, as to return the fluid by the mouth and nose. In attempt- 
ing to swallow solids, small particles of the mass sometimes become lodged 
upon the painful part, and occasion great suffering. This accident is the more 



Bibliographical Notices. 163 

distressing, as it occasions a great sense of dryness about the throat, which 
creates a desire for drinks that cannot be gratified, on account of the reasons 
already mentioned. 

*' In some cases, a manifest swelhng of the throat exists externally, which 
either corresponds to the whole extent of the larynx, or is confined to a small 
extent of that organ. This tumefaction extends, moreover, in some instances, 
to the adjacent glands of the neck. 

*' In the mouth, appearances are observed which have been hitherto over- 
looked, which nevertheless are important to be attended to, notwithstanding 
they do not exist in every case. The tongue, on the side corresponding to the 
seat of the pain, is covered from base to tip, with a thick, yellowish incrusta- 
tion, which is accurately defined by the median line of the organ, beyond which 
it does not extend. The other half of the tongue maintains its natural red co- 
lour. The incrustation is generally yellowish posteriorly, but of alight colour, 
near the tip of the organ. The root of the tongue, moreover, frequently under- 
goes considerable alterations in the last stage of the disease: it becomes thicker, 
of a redder colour; its papillae become prominent, and are smeared over with a 
whitish mucus, as though they were in a state of suppuration. 

*' At the commencement of the disease, there is sometimes no fever, or it is 
very slight, and comes on towards evening, with frequent, small pulse, and al- 
ternate chills and heat. The paroxysm does not last long, but soon declines, 
leaving the patient bathed with a profuse perspiration, which occasions a rapid 
wasting of the body. The influence of the disease upon the muscles of the 
larynx, tends to exalt their irritability to such a degree as to excite a spasmodic 
closure of the glottis, and thereby interrupt the entrance of the air into tlie 
lungs. Under these circumstances, the ^^pahulum vitx" can no longer reach 
the vascular net-work which is expanded upon the air cells, and consequently, 
the bodily powers become so debilitated, the nervous energy so enfeebled, that 
the patient does not usually subsist long enough to be consumed by colliquative 
diarrhoea, but falls a victim to apoplexy or an anginose affection, or he dies in 
consequence of the nervous energy of the air tubes being so far overcome as to 
destroy altogether the relations between them and the muscles of respiration." 

Such are the symptoms of this formidable malady, which, when it once fixes 
upon the system, suffers but few to recover from its ravages. Like consump- 
tion of the lungs, it is almost always fatal, recoveries being exceedingly rare, 
and seldom taking place in many cases, except those which owe their origin to 
the venereal virus. 

Our author has been at considerable labour in selecting examples of laryngeal 
phthisis, a great number of which he has detailed v^ith great care and precision. 
Examinations after death always revealed considerable alteration of texture 
about the larynx, which corresponded, in most cases, with the point in which 
the pain was located during the. life of the patient. These consisted, for the 
most part, of inflammation, with extensive ulceration of the mucous membrane 
of the larynx, as well as of the cartilages, glands, muscles, and ligaments — the 
development of fungous excrescences, a general thickening of the parts, and a 
complete annihilation of their natural characters. Several of these alterations 
are represented in the plates which are annexed to the volume. 

II. Phthisis Trachealis. 

After the description of the disease of the larynx, the symptoms of which 
have been detailed, our author enters into the consideration of the second form 
of the disease, called tracheal phthisis. 

This malady generally attacks those of njiid^le a^e:— " Galen observed it in 



164 Bibliographical Notices. 

a young- physician; Thomann in a female aged 29; Kraus in a woman of ^6-, 
Cayol met with it in one individual of 30, and in another of 49; Bayle mentions 
one of 39; Corvisart one of 40; Badham one of 47; Fouquier one of 50, and 
Morg-agni one of 80 years. It is characterized by hoarseness, pain in the tra- 
chea, cough, expectoration, difficult respiration, and hectic fever: a part of 
which symptoms are also common to it and laryngeal phthisis." These two 
affections nevertheless, our author thinks, may be distinguished from each 
other, notwithstanding the opinion of Thomann to the contrary. 

The most frequent cause of tracheal phthisis is, unquestionably, exposure to 
cold; a fact long since pointed out by Morgagni, who observes, that draughts 
of cold water, taken when the body is heated, produce consumption, not only 
by acting upon the lungs, but also upon the vessels of the trachea; it may also 
arise from suppuration of the adjacent glands, from blows, contusions, wounds, 
or even external pressure. 

The voice is at first slightly hoarse; some patients complain of an indescriba- 
ble sensation about the lower part of the trachea, which seems to affect the 
clearness of the voice, and which they endeavour to remove by hawking, or by 
an effort to cough. The natural timbre of the voice is, indeed, in almost every 
case, lost: it becomes rough, or hoarse, but seldom so much enfeebled as in the 
laryngeal phthisis. A distressing cough soon makes its appearance, which is 
increased during a meal, or by exercise. The expectoration is, at first, scanty, 
thin, and transparent: at a later period it becomes filiform, variegated with a 
yellowish puriform substance; and, more rarely, it is streaked with blood. In 
some instances it retains this character for a length of time, but gradually be- 
comes, in the end, of an opaque, yellow colour, offensive to the smell and taste, 
and of a genuine purulent character, generally intermixed, however, with more 
or less of a frothy, transparent mucus; occasionally, when the disease has ex- 
isted for a length of time, portions of the cartilaginous rings of the trachea and 
bronchia are brought up by a violent fit of coughing. This appears to have 
been noticed by Aretxus, inasmuch as he says, (page 86,) "asperiaarterise cir- 
culi nonnunquam expuuntur o,b ulceris varietatem,, si abscessus alte penetrat, 
Raucescunt, breve spirant, gravem vocem edunt, &.c." 

The uneasy sensation in the throat, which tends to provoke the cough, is by 
that act converted into pain, which is not, however, confined to a point, but 
seems to be seated in the lower part of the trachea, on a level with the upper 
part of the sternum. When the cough is severe, the patient often places his 
hand, involuntarily, upon this region; and when there is no cough, he occasion- 
ally complains of a sensation which he compares to the act of pressing from 
within outwards. This feeling sometimes extends deeper into the chest, be- 
hind the sternum, but always inclined shghtly to the left side. At first it is of 
transient duration; but is always increased towards evening, and interrupts the 
functions of the bronchia, the lungs alone preserving their ft-eedom of action. 

" The respiration is generally exceedingly difficult, so much so, indeed, that 
every two, three, or four days, the patient becomes affected with a sense of 
suffocation, which continues from a quarter, to two or three hours; even in the 
interval of these attacks, the breathing remains difficult, and is frequently ac- 
companied with a kind of rattling, or wheezing. The rattle is particularly strong 
during the fit, and for some time before it comes on. When the patient attempts 
to speak, it is particularly observable at the end of each sentence, and seems 



Bibliographicul Notices. 165 

to be owing" to the presence of the mucus which occasions an obstruction in the 
trachea. Every bodily effort disposes to these effects of dyspnoea. 

" The tongue is covered with a thick, yellowish incrustation; but the patient 
has generally a good appetite, and is not much emaciated. The deglutition is 
difficult, without there being any apparent inflammation of the throat. The pa- 
tient does not experience any difficulty in engaging the morsel in the pharynx, 
but experiences pain when it passes the region in which the inflammation of 
the trachea exists. 

"In most cases the patient dies before a well-marked hectic becomes esta- 
blished: instead of this, he experiences restless nights, a burning sensation in 
the palms of the hands, dryness of the skin; but all these symptoms are not so 
strongly marked as in other forms of consumption. The pulse is quick and fe- 
brile, but generally regular; it is sometimes different in the right and left arm. 
Towards the end of the disease there is often considerable swelling of the feet, 
a dark, red suff'usion of the countenance, with a disposition to syncope. The 
patient can lie, with equal ease, on either side, but cannot rest easily upon his 
back. During the paroxysm of dyspnoea he is often compelled to set erect, with 
his head thrown forwards upon his breast until the difficulty of breathing passes 
away. For some time before death the paroxysms are less violent, and do not 
recur so frequently. In some cases death takes place suddenly, while the pa- 
tient is in the act of changing his position, by which the matter, which had be- 
came collected in an abscess, finds its exit, and occasions suffocation. The pa- 
tient dies of all the accidents of consumption." 

These are the characters which, according to our author, characterize tracheal 
phthisis; an aff^ection which, as well as that described above, has been, until 
within a few years, too much confounded with phthisis pulmonalis. It is di- 
vided, by him, into three varieties, according to the nature of its origin: — 

1. " Primitive tracheal phthisis; or that which arises from the development 
of the suppurative process in the lining membrane of the trachea. 

2. *' Secondary tracheal phthisis; or that which is owing to abscess, indura- 
tion of the glands, or to cysts developed in any part of the trachea, or its vi- 
cinity. 

3. "Complicated tracheal phthisis, when it arises from ulceration of the 
throat." 

It will be seen, from this division, that the disease may originate from several 
causes, of which some are intrinsic, while others possess an extrinsic character. 
But as regards ultimate results, this does not seem to be of much consequence, 
inasmuch as all the researches of our author lead to the melancholy conclusion, 
that the disease is very generally fatal under any concurrence of circumstances. 

The anatomical characters of tracheal phthisis vary according to the nature 
of its cause. In most cases, however, the mucous membrane of that tube is 
found in a state of suppuration or ulceration; these conditions being either dif- 
fused or circumscribed, and confined to the membrane itself, or extended to 
the adjacent structures; as the cellular tissue, glands, cartilages, &c. We have 
already seen, that in some instances portions of the cartilaginous rings of the 
trachea are ejected with the expectoration; and it is by no means unusual, when 
the disease has been of long standing, to find them softened, eroded, and va- 
riously altered from their natural condition. 

But we have yet to examine the most important part of the work before us; 
or that which relates to the diagnosis of the two affections which have been de- 
scribed. The author has treated this subject somewhat minutely, and has de- 
tailed, with considerable care, the several phenomena which serve to charac- 

15* 



166 



Bibliographical Notices. 



terize the two diseases. The principal affections with which they are liable ta 
be confounded, are, according- to our author, thickening of the mucous mem- 
brane of the larynx, phthisis pulmonahs, aneurism of the aorta, caries of the os 
hyoides, and suppuration within the articulation of the atlas, with the dentatus. 
The diagnosis of each of these he considers separately; and we shall endeavour 
to follow him through his remarks. 



I. DiAGJfOSIS BETWEEN LARYNGEAL AND TRACHEAL PHTHISIS. 

It has been affirmed by Double, who has written an excellent memoir upon 
the subject, that the two affections cannot be distinguished from each other. 
Sauv6e and Cayol have attempted to point out some distinguishing characters, 
founded, mostly, upon the alteration of the voice and the seat of the pain. We 
think our author has been more successful in his attempt. 

§ 1. Alterations of Voice and Speech. 



Phthisis Laryngea. 
1. '*The voice is hoarse from the 
commencement, and this condition in- 
creases as the disease advances; it be- 
comes weak, scarcely audible, and 
finally extinct. 



2. " The patient cannot speak for 
any length of time in a loud voice, but 
whenever he attempts it his voice gra- 
dually fails, and a tickling sensation 
about the larynx takes place, which 
occasions a spasmodic action of the 
muscles of that tube, and excites more 
or less contortion of the face, a dispo- 
sition to sneeze, or interrupted respi- 
ration. 

3. " The first words which the pa- 
tient attempts to speak in the morn- 
ing are articulated with difficulty." 



Phthisis Trachealis. 

1. ** The voice is but shghtly, or 
not at all altered. The patient, more 
than the bystanders, is sensible of a di- 
minution of the sharpness of its tones, 
and endeavours, by frequent hawking 
or coughing, to overcome the sense of 
obstruction, which he feels about the 
upper part of the sternum. 

2. *' The speech is rather accompa- 
nied with a kind of hoarseness, which, 
with some individuals, continues 
throughout their entire lives, and is as 
well marked as that which is observed 
in hard drinkers. 



3. *' The articulation is the same 
throughout the day. It can only be al- 
tered by pressure upon the trachea or 
a change of position.'* 



From this, It clearly appears, that the alteration of the voice is much greater 
in laryngeal than in tracheal phthisis, and that that circumstance furnishes one 
important means of distinguishing these two affections. 



§2. Pain, 



Laryngeal Phthisis. 
'' c. Seat. The upper part of the la- 
rynx, to which the patient applies his 
hand involuntarily, when the pain is 
considerable. It sometimes extends be- 
yond this point, reaching the fauces, 
even when their natural aspect is un- 
changed, but seldom extending much 
downwards. 



Tracheal Phthisis. 
" a. Seat. Low down in the trachea, 
about the level of the bifurcation, sel- 
dom extending much upwards, but 
frequently reaching the bronchia, and 
manifesting itself behind the sternum. 
It seldom takes place in any other part 
of the chest, and then only when the 
diseased bronchia irritate the lungs by 
mechanical pressure. 



Bibliographical Notices. 



167 



•^'i. Nature. At first tickling, but af- 
terwards acute and continuous, prick- 
ing, lancinating, or similar to the im- 
pression which would be made by pe- 
netrating the larynx with any foreign 
body. 



*'c. Changes. Aggravated by the 
cough, 

" By external pressure, 

" By an impure atmosphere, or one 
intermixed with irritating substances, 

" By boisterous weather, 

"By heating remedies, 

" By speaking, riding, swallowing, 
and accidental inflammation, 

"By gargling with mustard or vine- 
gar, 

"By breathing with the mouth open 
during sleep. 

^' Diminished hy emollient vapours. 

"Duration. Generally continuous. 



" h. Nature. The pain at first is of 
the pressing kind, as though some- 
thing was pressing from within out- 
wards against the sternum. At a later 
period, when the cartilages become 
loosened, or when the disease pro- 
ceeds from extrinsic causes, it becomes 
acute and lancinating. 

"c. Changes. Aggravated by cough. 

" By external pressure in an infe- 
rior degree. 

" But little affected by an impure 
atmosphere, 

" Or by boisterous weather, 

" Or heating remedies, 

"By rotating the head upon the 
neck. 

" Not affected by stimulating gar- 
gles, 

" Nor by sleeping with the mouth 
extended. 

"It is not diminished by emollient 
vapours. 

" Undergoes considerable remis- 
sions." 



§ 3. Cough. 



1. " Each fit of coughing is preced- 
ed by a sense of tickling about the la- 
rynx. This is followed by a dry cough, 
which is frequently neglected. 



2. " It is excited by irritating 
gargles, by a damp, impure atmos- 
phere, and by the use of acids. It is 
not excited by exercise, when the pre- 
caution is used to hold a handkerchief 
before the mouth. 

3. " In most cases, it is violent in 
the morning, until something is brought 
up by expectoration. It is also trou- 
blesome throughout the greater part 
of the day, taking place in form of 
short, spasmodic succussions. It can be 
removed by pressure upon the larynx, 
but a sneezing takes its place; the 
cough again returning when the pres- 
sure is removed. 

4. "It is sonorous, and shrill, espe- 
cially, during an inspiration. During an 
expiration, it is wheezing, as though 
the patient breathed through a contrac- 
ted larynx; or it is somewhat croupal. 



1. " It is not preceded by any tick- 
ling, but an effort to expectorate is 
succeeded by a dry cough, coming on 
in paroxysms, accompanied with great 
bodily exertion, and a sense of suffo- 
cation. 

2. " It is not excited by the first set 
of causes, but so readily by the last, 
that towards the conclusion of the dis- 
ease, the patient is unable to take any 
exercise. 

3. " There is a slight teazing cough 
throughout the day, and at night it is 
so troublesome, as to deprive the pa- 
tient of all repose. 



4. "It is notsonorous, but is deeper, 
more hollow, hoarser, and more rat- 
tling, than the cough in bronchitis, and 
is unattended with wheezing. 



168 



Bibliographical Notices. 



5. «* In some cases, it comes on in 
strong paroxysms, which are brought 
on by the influence of external causes; 
much speaking", swallowing with pre- 
cipitation, the presence of inflamma- 
tion, the detachment of fragments of 
false membrane, or of pieces of carti- 
lage. 

6. " The cough is excited by the 
act of swallowing, and the food is 
thrown back in the incipient stage of 
the process. 



7. " During the cough, the patient 
seizes the larynx. 

8. *« Whatever is brought up by ex- 
pectoration, is without much effort, or 
with but little commotion of the chest. 

9. " The cough is easier at night, 
but is increased after rising in the 
morning. In the last stage of the dis- 
ease, it becomes so troublesome as to 
deprive the patient of all repose, and 
can only be quieted by large doses of 
opium." 



5. *' The cough is suffocating, inter- 
rupted, and attended with great suc- 
cussion and pain in the chest. 



6. " As the aliment approaches the 
chest, the rapid and incautious manner 
in which the individual attempts to 
swallow, tends to excite the cough, 
and the process is completed with 
more circumspection. 

7. " He applies his hand to the lower 
part of the neck; to the seat of the 
pain. 

8. " Expectoration brings great re- 
lief, and is only accomplished by con- 
siderable effort. 

9. " Aggravated whenever the pa- 
tient lies down." 



§ 4. Expectoration. 

In both diseases the cough is at first dry, but at a subsequent period, the ex- 
pectoration becomes considerable, in consequence of the implication of the mu- 
cous follicles, and the ulceration of the mucous membrane. 



Phthisis Laktngea. 
1. " The quantity of the fluid expecto- 
rated is inconsiderable when compared 
to the extent of the general sufferings. 



2. *' Sometimes it is bloody, but sel- 
dom presents that character. 



3. *« Sometimes it is mixed with 
small fragments of pseudo-membrane. 



4. Portions of cartilage are some- 
times brought up, which seem to con- 
sist of some of those of the larynx, ul- 
cerated and thickened. (See Mor- 
gagni, Hunter, Double, Sedillot.) 



Phthisis Trachealis. 

1. " The expectoration is much 
more considerable; partly, in conse- 
quence of the greater formation of pu- 
rulent matter, and, partly, from its ad- 
mixture with the mucous secretion. 

2. "It is more fluid and mucous, 
sometimes intermixed with small frag- 
ments, which sink to the bottom. 
When the glands are affected, it is 
sometimes brown, intermixed with 
small whitish coloured particles. 

3. "The same thing is sometimes 
observed. Towards the conclusion of 
the disease, it becomes thick, opaque, 
and highly offensive; but is still inter- 
mixed with a frothy mucus. 

4. " The fragments of cartilage, 
which are brought up, resemble more 
a portion of one of the cartilaginous 
rings of the trachea or broncliia. (See 
Aretseus, Riverius, Raulin.) 



Bibliographical Notices. 



169 



5. "The expectoration is brought 
up rather by a slight teazing cough, 
seated in the larynx, than a full, deep 
cough, extending profoundly into the 
chest; or as Thomann has it: continue 
excreavit sine tussi sputa purlformia," 
(p. 166-68.) 



5. " The patient can designate the 
point, in the lower part of the neck, 
from which the expectorated fluid is 
brought up. 



§ 5. Respiration. 



Phthisis Lartngea. 
1. " The difficulty of breathing 
comes on by degrees, but when once 
established, continues for some time in 
that state, and is often croupal. When 
the dyspnoea is most strongly develop- 
ed, the lungs remain free, and can be 
inflated with air if the spasm of the 
glottis will admit. Occasionally there 
are slight paroxysms of dyspnoea, which 
disappear, however, as soon as a little 
mucus is removed by expectoration. 

3. " The respiration is irregular or 
interrupted. 

3. " The breathing is shrill, fre- 
quently audible at a considerable dis- 
tance, and wheezing, especially during 
an inspiration." 



Phthisis Trachealis. 

1. ** The respiration is often dlfii- 
cult, but does not preserve that charac- 
ter for any great length of time. Parox- 
ysms of such violence take place, as to 
render it difficult for the patient to 
breathe, except in the upright pos- 
ture. These fits come on suddenly, 
and sometimes continue several hours. 
They are, however, so little in relation 
with the progress of the disease, that 
towards its conclusion, they often be- 
come less frequent, and much milder- 

2. "It is not interrupted by spasm> 

3. " The sound of the respiration is 
also altered; it is rougher, more rat- 
tling, or hronchitic; it seems to come 
from a depth, but the hoarse respira- 
tion is only observable during one of 
the fits of dyspnoea, when it can be 
heard at a considerable distance. In 
the last stage of the disease, the re- 
spiration is similar to that which is oc- 
casioned by the pressure of an aneu- 
rism of the aorta, upon the trachea." 

These are the principal symptoms, which, by being compared with each other^ 
and examined in relation with the individual affections to which they belongs, 
are to enable us to distinguish between laryngeal and tracheal phthisis. Dr. 
Sachse has detailed several others, which, however, being less to be relied upon^ 
we shall not examine particularly. They are sneezing, the mucous incrus- 
tation of the tongue mentioned above, disease of the fauces, difficulty of de- 
glutition, palpitation of the heart, fever, salivation, emaciation, &c. Many 
of these, it will be seen, belong equally to both affections; and can be of but 
little use in forming a diagnosis between them. The characters which have 
been already detailed, will, however, be sufficient to enable us to distinguish 
the one of these affections from the other. We shall next consider the diag- 
nosis between tracheal and pulmonary phthisis. 

Although it often happens that the one or the other of the diseases we have 
been describing, exists while the lungs remain in a healthy condition, yet, in 
many instances, the lungs are at the same time involved. Under these circum- 
stances, it is too apt to be inferred that the disease is not of a very dangerous 
character, while the lungs are not impUcatedj an opinion which the almost un^ 



170 Bibliographical Notices. 

varying- fatality of laryngeal and tracheal phthisis proves is far from being cor- 
rect. To form a diagnosis between phthisis trachealis and phthisis pulmonahs, 
we must consider the several symptoms by which they are characterized. 

1. Hoarseness. — Though it sometimes shows itself at the commencement and 
termination of pulmonary consumption, it does not, according to our author, 
constitute one of the essential symptoms of that disease. In proof of this, he 
states that an entire lobe of one of the lungs has been destroyed, without the 
patient evincing any hoarseness, and, indeed, scarcely any cough. It has been 
seen above, that hoarseness is a common symptom in laryngeal consumption. 

2. The Sensation about the Throat. — There is seldom much uneasiness about 
• the throat in pulmonary consumption; but the patient frequently complains of 

sharp pains in the chest, which are altogether wanting in laryngeal phthisis, 
and in phthisis trachealis only consists of a kind of sensation of forcing out- 
wards, experienced directly beneath the sternum. In pulmonary consumption, 
where the upper and posterior part of the lungs are affected, in consequence 
of the exposure of the nerves of the lungs to the irritation, and their connexion 
with the intercostal branches, the patient complains of acute pain between the 
shoulders. 

3. Cough. — It has been observed by Lieutaud and Morgagni, that in some 
cases of pulmonary consumption, the cough is entirely wanting. Dr. Sachse 
considers that such an occurrence is only possible where the ulceration is far re- 
moved from the bronchia. In pulmonary consumption, the cough is always 
worse in the evening, and is relieved by the perspiration which breaks out to- 
wards morning. In tracheal phthisis, on the contrary, the cough is most trou- 
blesome in the morning. 

4. Expectoration. — In laryngeal phthisis the expectoration is usually scanty; 
in the tracheal form of the disease, when most abundant, it consists of a thin 
fluid, intermixed with striae of purulent matter. In pulmonary phthisis, on the 
other hand, the patient is sensible of its coming from some profound part of 
the chest; it is more homogeneous, thicker, and more globular than in the dis- 
ease last mentioned, and is, in some cases, intermixed with small fragments of 
disorganized tubercles, or even of the tissue of the lungs. 

5. Respiration. — The respiration in pulmonary consumption does not present 
the croupal character which is observed in the other diseases; and in only a few 
instances does it present the paroxysms of dyspnoea which have been pointed 
out. *' Je n'en ai pas un seul qui ont presente les acces de suffocation, le rale 
et le slfllement de la respiration," (Cayol, 33.) 

6. Loss of voice, sterrf,utation, difficulty of deglutition, outward tumefaction of 
the neck, the incrustation confined to one side of the tongue, and the disposition 
to grasp the throat during a paroxysm of coughing, which are symptoms ob- 
served in laryngeal and tracheal phthisis, are not met with in pulmonary con- 
sumption; on the other hand, the haemopthisis, the phthisical conformation of 
the body, the purulent deposition in the urine, the wasting perspirations, the ina- 
hility to lie upon the side, the frequent recurrence of pneumonic inflammation, the 
hectic blush on the cheek, and the dull sound of the chest elicited by percussion, which 
are almost constant attendants on phthisis pulmonalis, are not observed in la- 
ryngeal and tracheal phthisis. In laryngeal phthisis, the respiration is inter- 



Bibliographical Notices, 171 

rupted: in pulmonaly consumption, the obstacle which opposes the full expan- 
sion of the lungs, renders it impossible for the patient to hold his breath for 
any length of time; and the expiration is consequently short and hurried. 

7. The duration of tracheal consumption is much shorter than that of pulmo- 
nary consumption; the latter often continuing- as many years as the former does 
months. 

By attending to these circumstances, we shall be enabled in most instances 
to distinguish between the diseases in question. Yet, even with the greatest 
precaution, and the most acute discrimination, we shall be too often exposed 
to error. To this dilemma we shall, indeed, be always exposed, so long as we 
trust to the ordinary means of examining diseases of the chest; and it will only 
be by availing ourselves of the advantages of the stethoscope, that we shall be 
enabled to escape from these difficulties. We are, therefore, sorry to observe 
that Dr. Sachse seems to be unacquainted with the use of that invaluable instru- 
ment, or that he has not availed himself of the important indications furnished 
by it in establishing the diagnosis in these diseases. 

We might next consider the diagnosis between the diseases already mention- 
ed, and aneurism of the aorta, and the several other affections alluded to above. 
We have, however, already extended our observations so far as to render it ne- 
cessary to bring them to a close. We have been induced to be thus minute, 
because, in the first place, we considered the matter of Dr. Sachse's work to 
be highly interesting, and, in the second place, because it purports to be a con- 
tinuation of the very able work of Wichmann, Ideen zu einer Diagnostick, 3 Bde. 
8vo. Helwing, 1794, 1802. In both respects we find much to commend, yet 
we think the author has indulged in numberless minute details, which would 
have been better omitted, as not leading to any very valuable conclusions. 

While we are on the subject of diagnosis, we cannot forego the opportunity 
thus afforded us of expressing our regret that we have not in the English lan- 
guage, a single work, proper to aid the student in this most difficult and impor- 
tant part of his medical education. It is true, the work of Marshall Hall con- 
tains much that is useful; but it is too defective, in both matter and arrange- 
ment, to supply the wants of the student, and can never be relied upon as a 
guide in this department of study. In France and Germany, where the subject 
of diagnostics is made an object of special study, several works of great merit 
have been published on the subject. In the former country, those of Landre, 
Beauvais, (Semiotique, Paris, 1818,) and Double, (Semiologie Generale, 3 vol. 
Paris, 1811, 1822,) are highly commendable; and in the latter, the works of 
Wichmann, Schmalz, (Versuch einer Mediz-Chirurg. DiagnostikinTabellen,HaL 
1816,) and Hufeland, (Conspectus Morborum sec. ord. nat. adjunctis characte- 
ribus specif. Diagnosticis, 1819,) have supplied what is so much wanted by the 
English and American student. It is too much the practice, under our present 
defective system of medical instruction, for the student merely to attend to the 
heterogeneous string of symptoms which are appended by authors and teachers 
to each malady, and to lose sight entirely of the proper value of each of these 
symptoms, as well in determining the precise seat of the disease, as its nature 
and the extent of its compHcations. Yet this is a kind of knowledge which we 
regai'd as of the most vital importance to the practitioner, and he who is des- 
titute of it, cannot, we maintain, practice his art with success, or even safety. 

E, G. 



17^ Bibliographical Notices. 



XII. Researches; principally relative to the Morbid and Curative Effects of Loss of 
Blood. By Marshall Hall, M. D. F. R. S. E., &c. London, 1830. pp. 303. 
8vo. 

The principal object of this work, as stated by Dr. Hall, is to apprise the in- 
experienced of some unexpected phenomena arising* from loss of blood — of the 
remarkable difference of tolerance or intolerance of loss of blood in different 
diseases — of the equal danger of an inefficient and undue use of the lancet — 
and of a rule which may be adopted to obviate this danger. Dr. Hall also at- 
tempts to estabhsh a distinction between irritation and inflammation in their re- 
spective effects on the system. 

The work is divided into two parts, with appendices to each. The first treats 
of the morbid effects of loss of blood; and the second of the curative effects 
of this evacuation. We shall briefly examine each of these. 

The detraction of blood is perhaps the most common mode resorted to in 
this country for arresting the progress of inflammations, and for relieving cer- 
tain morbid affections, and yet there is scarcely any one subject connected with 
the practical duties of our profession, that has received less attention than that 
of the due institution of blood-letting". In fact, in the detraction of blood we 
have been wholly acting on empirical principles; and the lancet has been in 
too many instances employed or withheld without the physician being- able to 
assign just grounds for his practice. But we will not attempt at this time to 
enter into any general consideration of this important topic, but will restrict 
ourselves to following Dr. Hall in his observations. The morbid effects of loss 
of blood, he observes, may be divided into the immediate, and into the more 
remote. The first, besides syncope, from its shghtest to its most fatal form, in- 
cludes delirium, convulsions, and coma. The latter comprising the states of 
excessive reaction, of defective reaction, of the gradual failure of the vital 
powers, and of more rapid or sudden sinking or dissolution. The latter have 
not received a sufficient degree of attention; we know of scarcely any author 
that has described them with accuracy. 

Under the head of the immediate effects of loss of blood. Dr. Hall first treats 
of syncope, the most familiar of all its results. This state is so well known that 
little that is new or interesting can be said on it. After syncope, convulsions 
are perhaps the most frequent consequences of a flow of blood. These are 
most apt to occur in children, and in cases of slow and excessive detraction of 
the circulating fluid, and always denotes that the remedy has been urged be- 
yond a safe degree: the same may be said of delirium, but it is important to re- 
mark that this latter state may ensue where a small quantity only of blood has 
been abstracted, depending on what Dr. Hall terms intolerance of loss of blood, 
or a morbid susceptibility to its effects. The other immediate effects of loss of 
blood are coma, and sudden dissolution; the first of these may mislead a cursory 
observer, from its resemblance to apoplexy, but an attentive survey of the 
symptoms will always make the case clear. 

The more remote effects of loss of blood, are — 1st. Exhaustion with exces- 
sive reaction. It is well known to every practitioner that exhaustion may as- 
sume several different characters. It may be attended with excessive, or with 
defective reaction, or with actual sinking of the vital powers. That, following or- 



Bibliographical Notices. 173 

dinary syncope is generally a simple return to a healthy state of the functions, 
or nearly so, the pulse not passing beyond its natural frequency. But where 
the haemorrhage has been profuse, the recovery is not so uniform, and the pulse 
may acquire and retain a morbid frequency for a certain length of time, which 
gradually subsides; but where exhaustion is induced by repeated blood-lettings, 
all the symptoms of an excessive reaction may supervene; these are very well 
detailed by Dr. Hall, and deserve close attention. In this state of exhaustion, 
sudden death has ensued from muscular exertion on the part of the patient, or 
from his being rapidly raised from a recumbent posture. 

2d. Exhaustion with defective reaction. This occurs most frequently in in- 
fants, in feeble persons, and in rather advanced years; this state either gradually 
yields to returning strength, or subsides into sinking; by this is meant a state 
of positive and progressive failure of the vital powers. One of the first indica- 
tions of it, says our author, " is to be found in the supervention of a crepitus in 
the respiration, only to be heard at first on the most attentive listening, but gra- 
dually becoming more audible, and passing into a rattling in the bronchia and 
trachea." This state. Dr. Hall thinks, involves a greatly impaired condition of 
the brain, and may be compared in certain points to that induced by apoplexy, 
or from dividing the eighth pair of nerves. This opinion is confirmed by the 
observations of Andral, who says that the lungs present similar appearances to 
those of animals in whom the pneumogastric nerves had been divided, or of In- 
dividuals who died apoplectic. 

It sometimes happens "that the most prominent symptom in exliausiion from 
loss of blood is a state of amaurosis." This has been observed by several 
writers, but more especially by Mr. Travers, from whose work Dr. Hall makes 
a copious extract, of which practice he is too fond, for instead of merely men- 
tioning that his opinion is confirmed by certain authors, he loads his pages with 
their cases and arguments at full length. He thinks that the symptoms of ex- 
haustion with reaction have frequently been mistaken for those of inflammation, 
and that recourse has too often been had to the further detraction of blood. 
This is the more likely to ensue, as all the symptoms are greatly relieved by it 
for the moment, though eventually they return in a more aggravated form. It 
should be observed, that in cases of exhaustion with reaction, syncope is very 
soon produced by the further loss of blood, and should always be regarded a> 
a warning against the further and inconsiderate use of the lancet. Where 
the detraction of blood is repeated still further, not only syncope, but a state 
of sinking is induced, which is either rapidly followed by dissolution or by it 
gradual failure of the vital powers. 

As relates to the influence of various circumstances in opposing or inducing 
the phenomena of exhaustion in cases of loss of blood. Dr. Hall remarks, tht 
first and principal is that which relates to the strength of the patient, as, ceteris 
paribus, the degree of reaction is in proportion to it. Thus, in infancy, in de- 
clining years* and in the feeble in constitution, there is defective reaction after 
loss of blood, and the state of syncope is always one of danger, whilst repeti- 
tions of venesection are usually borne with difficulty. In youth, and in the vi- 
gorous and robust, on the contrary, the reaction is strong, and especially marked 
after repeated bleedings. 

The other circumstances which exert an influence on the effects ot* loss of 
No. XL— May, 1830. 16 



1 74 Bibliographical Notices. 

blood are certain states of disorder, but as the author discusses these at more 
leng-th in a subsequent part of his work, we will not notice them at present. 

Dr. Hall seems to think that there is reason to suppose that a state of exhaus- 
tion from loss of blood may lead to effusion into the ventricles of the brain, and 
that such a state is no protection ag-ainst an attack of sang-uineous apoplexy; 
the latter of these positions he supports by the authority of Denman and Hey, 
and details some cases from them in corroboration. 

"After the brain," says our author, "it becomes necessary to examine the con- 
dition of the lungs, and it is by the stethoscope, that the very first symptoms of 
sinking- from loss of blood will be discovered. The bronchia first become 
clog-g-ed, the lung's become (Edematous, and the arterialization of the blood is 
defective." 

" The state of flatulency, sometimes almost amounting to tympanitis, and the 
fcEtid evacuations of the intestines, sufl^ieiently denote the morbid condition of 
that internal organ." 

Dr. Hall next proceeds to the consideration of the treatment of the effects of 
loss of blood, which he properly observes must be resolved into that which is 
general or constitutional, and that which is local, and must vary according to 
the peculiar state or stage of these effects. 

*' When syncope assumes a dangerous form, the principal remedies are, an 
attention to the posture of the patient, stimulants, and chiefly brandy and the 
transfusion of blood. The effect of posture is not even now fully known. It 
would be easy to allow the patient to lie over the edge of the bed, the head 
low upon the floor, and the feet greatly raised. In this manner such pressure 
would be restored to the encephalon as would in many cases support life, until 
other remedies being administered the patient might be placed out of imme- 
diate danger." 

This appears to us to be carrying the matter too far, for although a low 
position of the head is certainly advantageous, this hanging a patient with 
his head down, would, we are inclined to think, substitute greater evils 
than those it was intended to remove. 

We need make no observations on the importance of diffusible stimulants 
in such cases, their efficacy is too well known to every practitioner to need 
comment. 

As regards transfusion. Dr. Hall does not give any decided opinion, though, 
from the tenor of his remarks, we presume that he is in favour of it. He justly 
observes, that it too frequently happens that the proper period of adopting this 
measure is allowed to escape. Notwithstanding the cases which have been lat- 
terly detailed, in which transfusion was resorted to, in cases of uterine haemor- 
rhage, with apparent success, we are by no means persuaded that this remedy 
is as efficacious as its advocates appear to think it. In some of the cases it is 
very evident that the recovery was more attributable to the natural reaction of 
the system, than to the small quantity of blood injected into the veins. 

In all these cases of syncope, a due attention must be constantly paid to as- 
sist the arterialization of the blood by the admission of fresh air, and to sustain 
the natural heat by proper clothing, and especially warm applications to the 
feet. 

In cases of excessive reaction, ** the remedies appear to be, first, extreme quiet 
of body and mind, then the mildest sedatives, especially the hyosciamus? thirdly, 



I 



Bibliographical Notices. 1 75 

the mildest nutriments; and lastly, and above all, time. It may be necessary to 
subdue the throbbing action of the head by local blood-letting-, and it is re- 
markable how small a quantity of blood being" taken will relieve. Two or three 
leeches are frequently quite sufficient. But the most unequivocal remedy is a 
cold spirituous lotion, applied over all the head by means of a cap consisting of 
one fold of a stocking." 

In the administration of diffusible stimulants in exhaustion with sinking, Dr. 
Hall remarks, that great caution is requisite. Too much stimulus would hurry 
the action of the heart. The proper criterion for their use, is, that they should 
allay the morbidly increased action of this organ. For this purpose opium has 
also been recommended, but it should be given in small doses, and its effects 
closely watched. 

The first appendix to part the first is devoted to tlie consideration of the si- 
milarity between loss of blood, and the bloodlessness of chlorosis. These Jtwo 
diseases. Dr. Hall observes, resemble each other in many particulars, as the ge- 
neral symptoms, the tendency to affections of the head resembling arachnitis, 
and to affections of the heart simulating organic diseases of that organ; the con- 
dition of the general surface, of the capillary and larger circulations, the prone- 
ness to oedema and serous effusions. 

The differences that exist between them arise from the different modes of 
their accession, the loss of blood being a simple event, whilst the bloodlessness 
of chlorosis is the gradual effect of a previous state of complicated disorder. Dr. 
Hall supports this opinion by some cases, which prove we think little more 
than, that in the advanced stages of chlorosis there may be effusion in the brain 
or thoracic cavity, as the case of sudden death was attended with similar cir- 
cumstances as those occurring from hydrothorax. 

The second appendix, on a hydrencephaloid affection of infants arising from 
exhaustion, is extremely interesting. This subject appears to have attracted 
much attention from the author, and has also been treated of by Dr. Abercrom- 
bie in his *' Researches on the Diseases of the Brain and Spinal Marrow," and 
Dr. Gooch in his recent work on "Some Diseases Peculiar to Women." 
This form of the disease having received little notice in this country, we shall 
give a full analysis of this portion of the work. 

After premising that certain diseases of children appear to be well understood, 
Dr. Hall goes on to say, '* but there is another source of disorder in inftmcy, 
less frequent perhaps in its operation, but not less important in its consequences 
and far less understood by medical men, in exhaustion. This exhaustion has its 
origin in early infancy, chiefly in diarrhoea or catharsis; in the later periods o 
infancy, in the loss of blood, with, or without the relaxed or evacuated condi- 
tion of the bowels." 

He is also of opinion that the greatest proportion of fatal cases of disease in 
infancy, are attributable to an undue application of exhausting remedies. This 
is true to a certain extent, but not to that laid down by our author; we have 
been too apt in our treatment of infantile diseases, to think that we have ful- 
filled our duty, if we have bled and purged enough, when perhaps we have 
been exasperating irritations of some of the tissues that would have subsided 
without danger or difficulty under a milder course of practice. 



176 Bibliographical Notices. 

Dr. Hall divides the disease under question, into two stages, that of irrita- 
bility, and that of torpor; in the former there appearing to be a feeble attempt 
at reaction, and in the latter a complete prostration of the nervous powers. 
This morbid affection is usually induced by some derangement of the chylo- 
poietic viscera, as diarrhoea, exasperated by the too free use of purgatives. The 
child " becomes irritable, restless, and feverish, the face flushed, the surface 
hot, and the pulse frequent; there is an undue sensitiveness of theTierves of 
feeling, and the little patient starts on being touched, or from any sudden noise, 
there are sighing, moaning during sleep, and screaming, the bowels are flatu- 
lent and loose, and the evacuations are mucous and disordered." In such a state 
of things, if the nature of the affection be mistaken, and evacuations persisted 
in, the subsequent exhaustion is apt to lead to a very different train of symp- 
toms. " The countenance becomes pale, and the cheeks cool or cold, the eye- 
lids are half-closed, the eyes are unfixed, and unattracted by any object placed 
before them, the pupils unmoved on the approach of light, the breathing, from 
being quick, becomes irregular, and affected by sighs, the voice becomes 
husky, and there is sometimes a husky, teasing cough, and eventually, if the 
strength of the little patient continue to decline, there is crepitus or rattling 
in the breathing, the evacuations are usually green, the feet are apt to be cold." 
In these cases, as in those in which the strength of the child has been subdued 
by an undue abstraction of blood, stimuli are absolutely required; a treatment 
founded on an erroneous idea of a primary cerebral affection, only adding to 
the danger. 

In all cases of hydrencephalus we should be upon our guard not to mistake 
the stupor or coma, into which the state of irritability is apt to subside, for the 
natural sleep, and an indication of returning health. 

The remedies for this morbid affection are such as will check the diarrhoea, 
afterwards regulate the bowels, and restore and sustain the strength of the lit- 
tle patient. In the state of irritability the warm bath is a remedy of great effi- 
cacy, and during the coma, blisters or sinapisms to the nape of the neck are of 
service. In every case the extremities are to be kept warm, and the circulation 
in them promoted by frictions. The patient should never be suffered to assume 
an erect posture. 

Dr. Hall gives some extremely interesting cases occurring in his own prac- 
tice, and that of others, strongly corroborative of his opinions on this subject, 
and we regret that our limits will not permit us to subjoin them. This ques- 
tion, and that of exhaustion in children, open a wide field for investigation, as 
they are not only imperfectly understood, but highly erroneous opinions exist 
on them. 

The two next appendices, on exhaustion arising from other sources besides 
loss of blood, and that from abstinence, are very short, and contain nothing de- 
serving of notice. The last, on the state of sinking, however, is worthy of at- 
tention, as it relates to a subject which, though familiar to every practitioner, 
is one on which no settled opinions appear to exist, and yet it is of the utmost 
importance to distinguish this state, both on account of the prognosis and treat- 
ment. 

*' Amongst the first effects of the sinking state, is frequently the subsidence 
of some painful symptom as delirium, cough, or even pain itself, into a state of 



Bibliographical Notices. Ill 

ease, or perhaps of dosing". This event is continually mistaken by the patient 
and his friends for a favourable alleviation of the disease ^ the physician himself 
even may leave his patient in hope, may raise the hopes of relatives, and may 
even propose to postpone his succeeding" visit under this false impression, when 
perhaps the patient is dosing" to awake no more." 

In cases of sinking from exhaustion, there is obviously a failure of the powers 
of the whole nervous and secretory systems, manifested by its effects on the 
functions of the brain, heart, lungs, and intestinal canal, but where this state 
occurs from oppression of the brain, the mechanism of respiration is chiefly af- 
fected; and when the sinking" arises from a clogg"ed state of the bronchia and 
air cells, there is manifestly a defective arteriahzation of the blood; and lastly, 
if it takes place in certain affections of the stomach and bowels, as gastritis or 
enteritis, &c. there is g"reat, and oftentimes sudden failure of the circulation, in- 
dicated by an extremely small pulse, with a cessation of pain. 

A correct view of this subject is extremely important'in making a prognosis, 
and the physician should be fully aware of the fallacy of some symptoms of ap- 
parently a favourable chal-acter. Dr. Hall is of opinion that one of our best 
guides is the presence or absence of the crepitous rattle hitherto spoken of. 
** From the moment," says he, " this peculiar symptom is observed, it may, as 
far as our present means extend, be regarded as of fatal omen." In this we do 
not agree with him, at least to this extent, as we have seen more than one in- 
stance of recovery after this symptom had been fully established, though there 
can be no doubt but that it is, in most cases, a peculiarly bad omen. 

There are several other symptoms besides the crepitus, which usually attend 
this state. '* These are a species of inflammation of the conjunctiva, arising I 
believe from the eyes being for a long time imperfectly closed; great and irre- 
gular frequency, and a feebly vibrating character of the pulse; dosing; sighing 
in the breathing; difficult digestion; a tympanitic tumidity of the bowels; reten- 
tion of urine, and involuntary evacuations." 

Part the second, embraces the consideration of the curative effects of loss of 
blood. 

It is well known to every practitioner, that patients of similar strength and 
constitution, but affected with dissimilar diseases, are differently affected by a 
sanguineous evacuation. Some will faint before four ounces are taken away, 
whilst others will bear fifty or sixty without syncope being induced. The ra- 
tionale of this is to be found in connexion with the fact of the different suscep- 
tibilities of the system induced by different diseases. 

Dr. Hall has given the following scale of these properties: — 

"Persons in health, and of moderate strength, will generally faint, if bled in the 
erect posture, on taking fifteen ounces of blood. I have known seventy to be taken 
in the sitting posture, in the tendency to apoplexy without syncope, but the case 
is an extreme one. Patients with pleuritis or pneumonia frequently lose thirty- 
five ounces, without fainting. In bronchitis little more is borne to be lost than in 
health. A stout person in fever will frequently faint on losing ten, twelve, or 
fourteen ounces of blood. In intestinal irritation, with urgent symptoms even, 
the abstraction of nine or ten ounces will generally induce deliquium. In deli- 
rium tremens, or puerperal delirium, the patient soon faints from loss of blood. 
The same thing is still more observed in those cases of violent reaction which 

16* 



178 Bibliographical Notices. 

arise from the loss of blood itself. In dyspepsia, hysteria, and chlorosis, the sus- 
ceptibility to syncope from loss of blood is very great," 

Dr. Hall thinks that the quantity of blood which flows, when a patient re- 
quiring- full blood-letting, is placed upright and bled to deliquium, is accurately 
proportioned to the exigencies of the case, and the powers of the system. This 
rule is also suited to the degree and duration of the disease, for, with each of 
these, its influence in inducing tolerance or intolerance of loss of blood is re- 
spectively augmented. 

As much injury has been done by an inefficient, as by an undue use of the 
lancet; from both these extremes. Dr. Hall says the rule just alluded to will 
guard us. An important question relates to a repetition of blood-letting. But 
we may lay it down as a rule, that it should be prompt, according to the to- 
lerance of loss of blood in the previous venesections. It is never safe to bleed 
to deliquium in a recumbent posture, as more blood may be abstracted than 
comports with the real exigencies of the case. 

Dr. Hall next enters upon the consideration of particular diseases in their re- 
lation to the Joss of blood, and the first he notices is fever, the theory of which 
he does not appear to clearly understand. His idea is, that fever differs from 
inflammations, in being an affection of the whole nervous and vascular systems, 
instead of an affection of these systems in one part or organ. We shall not, 
however, attempt in this place to enter into a discussion of this knotty point, 
but will confine ourselves to the subject of blood-letting alone. " There are 
three circumstances in fever," says owr author, "which should lead to the use 
of the lancet. The first is, excessive reaction of the vascular system; the se- 
cond, much excitement of the nervous system, especially violent delirium, and 
the third and the most imperative, the existence of local inflammation." The 
two first require the lancet to be used with great caution, but in the latter it 
may be used freely. 

In inflammation, a state of the system is induced, which protects it from the 
influence and effects of loss of blood; it in fact acts as a concentrated and per- 
manent stimulus, in exciting and maintaining the powers of the system. Even 
syncope does not remove it, but merely subdues the constitutional effects of 
this stimulus. 

Dr. Hall is not an advocate for pushing the abstraction of blood to actual syn- 
cope, but only to the first signs of its approach, and highly deprecates the use 
of the lancet, after the inflammation shall have been subdued. 

His next cliapter is on irritation, which we must confess we do not clearly 
comprehend; his ideas on this subject are so much at variance with all physio- 
logical facts, that it is difficult to ascertain what he really means by irritation. 
We will, however, give his views, and leave our readers to draw their own con- 
clusions. 

" The most frequent cause of this affection is a disordered state of the con- 
tents of the colon, the next is some indigestible substance taken into the sto- 
mach, with some superadded cause, some shock sustained, or some effort made 
by the system, which rouse into activity the cause of irritation otherwise dor- 
mant. The effects of intestinal or nervous irritation, are chilliness, varying from 
coldness of the extremities to extreme rigor, followed by great heat of the sur- 
face, and symptoms resembhng those of arachnitis or peritonitis, singly or sue- 



Bibliographical Notices. 179 

cesslvely in their most acute forms, but especially arachnitis; more rarely there 
is pain resembling that of pleuritis; more rarely still, a peculiar pain passing 
along one side of the neck to the shoulders, and occasionally, generally after 
blood-letting, there is palpitation of the heart." 

These symptoms, he says, have usually been confounded with inflammation 
of the organs chiefly affected, to the great injury and even danger of the pa- 
tient, particularly in that form resembling arachnitis. 

The forms of this morbid affection, which simulate peritonitis and pleuritis, 
are equally characterized by alternate chill or rigor, and heat, frequency of the 
pulse, and susceptibility to the effects of loss of blood. 

Dr. Hall then proceeds with a further detail of its symptoms: — 

*' It generally begins in the manner of a sudden attack. This attack is usually 
ushered in by rigor, indeed by a more distinct and decided rigor than is observed 
in many cases of inflammation; the rigor is usually soon followed by much heat of 
surface; with the heat, the patient experiences some affection of the head, chest, 
or abdomen, and indeed, frequently of all; there are vertigo on raising the head, 
pain and some morbid impression on the mind, panting in the breathing, flut- 
tering about the heart, with general hurry, irritability, and restlessness; the 
tongue is white and loaded; the alvine evacuations are morbid, dark coloured, 
fcetid and scybalous, or yellow like the yolk of an e^^, or of the appearance of 
yeast; the urine is turbid and frequently deposits a copious sediment. The af- 
fection of the head consists of the most acute pain, the greatest intolerance of 
light and sound, and the severest form of vertigo; wakefulness, and distress, 
and sometimes even delirium, and the pupils of the eyes are often extremely 
contracted. The affection of the chest is denoted by severe and acute local 
pain, which is apt to vary its situation, passing from one side to the other, or to 
the back, or occupying a situation higher up or lower down." 

When the abdomen is affected, there is acute pain and tenderness on pressure, 
both of whichDr. Hall is of opinion, are not invariable pathognomonic signs of in- 
flammation. If the heart be the seat of this disease, there are violent and terrific 
attacks of palpitation, both- in this organ and in the carotids and abdominal 
aorta. 

The mode of treatment he recommends, is a full evacuation of the stomach 
and bowels, anodynes, light nourishment, and certain local remedies, as cold 
lotions to the head, and fomentations and liniments to chest or abdomen. The 
lancet, he thinks, is scarcely ever needed. 

The next subjects of discussion are, accidents and operations. In these, his 
observations deserve attention, as practitioners are too apt to bleed before a reac- 
tion of the system is estabhshed. The lancet should never be used after any 
severe remedy, during the continuance of the collapse of the system. 

As regards the due institution of blood-letting, Dr. Hall makes some just re- 
marks, though they are in general a repetition of those we have already quoted. 
With respect to the time when this operation should be practised, there can be 
but little doubt. Where a disease requiring this evacuation is formed, the sooner 
it is resorted to, the better. A single bleeding at this time is more effectual, 
and much less dangerous than if delayed, besides which, less blood is required 
to be drawn to answer the desired end. 

The necessity and propriety of a first blood-letting must be determined by 



180 Bibliographical Notices. 

the diagnosis of the disease, and a due estimation of the powers of the patient; 
this being- determined, the next question is, what quantity should be taken? 
This can only be solved, in many cases, by watching* the effects of the loss of 
blood as it flows. " And yet the usual mode of proceeding" is, to prescribe the 
quantity of blood to be drawn, and forthwith to leave the patient in the hands 
of one from whom, however competent, the right, or at least the freedom of 
judgment is thus preposterously taken." 

We have long been of opinion, that the usual practice in our large cities, 
and particularly Philadelphia, of leaving the patient in the hands of a mere 
bleeder, is fraught with evil consequences. Venesection, to be attended with 
its full effects, should always be employed under the eye of the practitioner 
himself. It is almost impossible for any one to decide what quantity of blood 
it may be necessary to abstract, by a priori reasoning. 

The rule laid down by Dr. Hall, may obviate some of the evils arising from 
this mode of practice, though even this cannot supercede the necessity of a 
physician being present at the operation. His rule is to place the patient in 
an erect posture, and to make a moderate-sized orifice, permitting the blood to 
flow until incipient syncope occurs. The administration of the remedy is thus 
accurately suited to the nature and degree of the disease, and to the powers and 
susceptibilities of the patient. There are some limitations and exceptions to 
this rule which require to be noticed. Thus the case may be so mild as not to 
requite so great an abstraction of blood. It is also requisite to observe whether 
the patient's feet are warm; otherwise less blood may flow in inducing syncope 
than will be required to subdue the disease. There is also danger in bleeding 
to syncope from a small orifice, as a much larger quantity will be required to 
produce this effect than is consonant with safety. 

In determining the question of the propriety of a repetition of blood-letting, 
many circumstances must be taken into the account. But we may assume as a 
general rule, as long as blood-letting is required it can be borne, and as long as 
it can be borne it is required. Dr. Hall very justly thinks that little reliance is 
to be placed on the appearance of buff upon the blood. It is always afallacious 
guide as regards the repetition of venesection. 

Dr. Hall very properly protests against the use of the lancet as a preventive 
of disease. Of all cases in which blood-letting has been employed, none is so 
replete with danger. The lancet should never be used until the appearance of 
symptoms requiring its employment. 

*' Local blood-letting may be regarded in three points of view. First, it is 
useful as an auxiliary to general blood-letting in cases of inflammation; second- 
ly, it is proper in some cases of irritation, in which general blood-letting could 
not be borne; and thirdly, it may be required in cases in which general blood- 
letting would be fatal." 

The last chapter is on blood-letting in infancy and childhood. Children are 
more susceptible than adults to the insidious and often fatal effects of loss of 
blood, and require it to be used with great caution. 

" The proper mode of abstracting blood in infants or children, whether by 
leeches, cupping, or venesection, is to place the little patient upright, and watch 



Bibliographical Notices. 181 

the countenance. On the first indication of palor or faintishness, the flow of 
blood must be stopped." 

Dr. Hall has subjoined a plan of a register of cases of blood-letting, which 
would be a most useful record, if properly kept; and we cannot recommend 
such a detail of facts, to practitioners in too high terms. It would do more to 
place the practice of venesection on a firm and useful basis than any other that 
could be devised. 

It will be seen that we have been much pleased with Dr. Hall's work gene- 
' rally; we think that it is calculated to do much good in placing the subject of 
the due institution of blood-letting on a practical basis. Its principal fault is 
constant and unnecessary repetitions. 

R. E. G. 



Art. XIIT. Memoire sur VJingine Epidemique, ou Diphtherite. Par F. P. 

EMAiiGAKD, Docteur en Medecine de la Faculte de Paris, a Paris, 1829, 8vo. 

pp. 90. 
Memoir on the Epidemic Angina^ or DipJitheritis. By F. P. Emangard, M. D. 

Paris, 1829. 8vo. pp. 90. 

The author of this production is a zealous disciple of Professor Broussais, and 
of course his reasonings and mode of practice have a direct reference to the doc- 
trines of the physiological school of medicine. Though we are not ourselves a 
complete convert to these doctrines, yet we have always endeavoured to be 
open to conviction, and we must confess that the present memoir has gone far 
to confirm our favourable opinion of them. 

The writer has endeavoured, and we think with some success, to prove that 
the epidemic angina or diphtheritis of M. Bretonneau is not, as supposed by that 
gentleman, identical with croup, but has its origin in the stomach, the anginose 
affection being preceded or accompanied by gastro-enteritis; and he maintains, 
contrary to the opinion of Mons. B. that diphtheritis does not essentially differ 
from scarlatina anglnosa. 

The result of the observations of Dr. Bianquin of the Arrondissement de Mor- 
tagne, where this epidemic prevailed in 1827, on more than three hundred pa- 
tients treated by him, was that all those who were bled from the arm at the com- 
mencement, and the venesection repeated from the first to the second day, re- 
covered. 

M. Martin, a physician of Moulins-la-Marche also stated to the author, that he 
had occasion to treat seventy patients affected with this disorder, (during its epi- 
demic prevalence in the cantons of Moulins, Bazoches, and Courtomer,) in all of 
whom the invasion of the disease was marked by symptoms of gastro-enteritis. 

It may not be improper to state the topography of the district in which these 
cases occurred as related by M. Martin; it is situated not far from the shores of 
the Sarthe, which takes its rise in the commune, and near the church of Saint 
Aquilain, and is subject to frequent inundations of its banks. It is bordered by 
low and humid meadows, which are inclosed by very high hedges. There are 
frequently disengaged from these meadows, whose level is about fifty metres be- 
low that of the surrounding country, thick mists charged with gas of a very pe^^ 



182 Bibliographical Notices. 

netrating" and disagreeable odour. In this section of country the habitations are 
low, moist, and both badly ventilated and paved. The yards of the cultivators 
among whom this malady most frequently manifests itself, are occupied by pools 
and dunghills, which exhale an animal gas of a very disagreeable smell. 

The inhabitants are engaged in agricultural pursuits, living on bread more or 
less badly prepared, into which barley and rye largely enter as constituents, to- 
gether with milk, cheese, fruits, &c. drinking cider when the seasons are abun- 
dant, and rarely eating meat. 

Several interesting cases are detailed by M. Martin, which we are constrained 
to pass over, noticing however, as we proceed, the remarks of Dr. E. respect- 
ing them. "In all the patients treated by Mons. M." says he, "the signs of 
gastro-enteritis have always been the first observed. General bleedings were 
employed with constant success, but did not always prevent the development of 
serious occurrences, although repeated from the commencement of the disease, 
which the application of leeches to the epigastrium would, I believe, have pre- 
vented." Our author had an opportunity in the year 1828,* to apply his prin- 
ciples to practice. That year was characterized by frequent and abundant rains; 
the portion of country where this epidemic presented itself is cut up by dales, 
at the bottom of which there flow small streams subject to inundations; and it 
is well covered with underwood, fir trees, and forests, combining all the causes 
of a permanent humidity, and a temperature nearly always cold. The inhabi- 
tants are located in these dales, on the borders of the woods, or in the midst of 
orchards, so as to be nearly deprived of the beneficent influence of the sun, and 
at the same time exposed to the action of marshy exhalations. Here an epide- 
mic scarlatina made its appearance towards the end of February, 1828, and con- 
tinued until autumn. Symptoms of gastro-enteritis either preceded or accom- 
panied its development in every patient; leeches to the epigastrium at the com- 
mencement always disposed to a favourable termination, and frequently averted 
the angina and cutaneous eruption. 

When this remedy was neglected, serious and often fatal occurrences result- 
ed; the angina extended sometimes to the larynx, and produced the diphtheritic 
croup of M. Bretonneau. The scarlatina had disappeared or become very rare, 
when, in last October, he was called by M. Dubois, who stated that a girl aged 19, 
had fallen a victim to a gangrenous sore throat, and another aged 10, who was 
labouring under croupal dyspnoea, accompanied with delirium, perished in the 
night. A third, aged 15, had nausea, vomited and complained of constriction 
in the throat; the tonsils were red, swelled, and covered, especially the left, 
with a thin whitish pellicle; the pulse was hard and contracted; the abdomen 
excessively hot; the pulsations of the descending aorta and of the coeliac trunk, 
produced a true percussion strong and unusual, but distinctly perceivable, at- 
testing that the abdominal arteries were in a high state of irritation; these pul- 
sations had also been remarked in the other two girls, who had before sunk un- 
der the disease. 

Under the conviction that the abdomen was the primitive seat of the disease 
which it was important to arrest, in order to prevent its extension to the brain, 

• Dans les Environs de I'Aigle. 



Bibliographical Notices. 183 

producing delirium, and the angina pharyngo-tonsillaris from becoming conse- 
cutively the croup of M. Bretonneau, our author applied thirty leeches to the 
epigastrium, and prescribed diluent drinks, emollient clysters, gargles, &c. 

The angina was arrested; the symptoms of gastro-enteritis ceased, and very 
soon the inflammatory redness of the tonsils disappeared. Six other patients in 
the same house were attacked with the like formidable symptoms, to which the 
beforementioned means were applied, except that to two of them the leeches 
were repeated to the second or third time: delirium did not occur to any of 
these patients. 

It would be tedious to detail all the cases mentioned by Dr. E. ; suffice it to 
say, they were all treated on the same principles, and with marked success. He 
observes, '*I have seen a great number of individuals perish, who were attack- 
ed with this disease, because they had neglected the sanguineous evacuations 
from the epigastrium, or very abundant general bleedings." 

The epidemics described by Huxham, Planchon, Tissot, and Rosen, had for 
pathognomonic signs more or less aggravated symptoms of gastro-enteritis; but 
the most interesting evidence adduced by our author in support of his principles, 
is from the work of Vincent Ketelaer, a physician of Zealand, published in 1669, 
entitled ** Commentarius de aphthis nostratihus sen Belgarum Sprouw," "a dis- 
ease,'.' says Dr. E. *' which is nothing more than a phlegmasia of the mucous 
membrane of the digestive passages extending from the posterior part of the 
mouth to the tonsils and pharynx, producing pellicular concretions, which the 
authors calls pustules to distinguish them from aphthse, properly so called, but 
which uniting and increasing in thickness, cover uniformly all these parts, and 
detaching themselves by fragments, ffrustulaiim,J do not leave any trace after 
them of their existence; an affection in one word, offering in its attack, its pro- 
gress and its terminations, the same phenomena as the diphtheritis or epidemic 
sore throat of authors." Bleeding or repeated purgatives succeeded well before 
the aphthae had attained their entire development, but ceased to be applicable 
when this had occurred. When venesection had not been practiced at the com- 
mencement the affection became more malignant and dangerous, and in the ad- 
vanced stages it would have been the height of temerity to have recourse to 
blood-letting. 

" Who does not see," says our author, " in this succinct extract from the work 
of Ketelaer, the answer to all that has been said by M. Bretonneau, and repeated 
by his echos on the nature of diphtheritis, and on the danger of bleeding in its 
treatment? 

"If like the Zealand physician, these gentlemen had appreciated the epoch of 
the disease, which no longer allows the employment of blood-letting, they would 
not have drawn this evidently false conclusion from their observations, that diph- 
theritis is a specific phlegmasia." 

Dr. E. now proceeds to point out the analogy between angina maligna and 
typhus fever; and in support of his principles he adduces the testimony of Ramaz- 
zini, and also of Aretaeus of Cappadocia, who, in describing a disease, which he 
terms ulcers of Egypt or Syria, details symptoms which are in effect the same 
as those which manifest themselves in epidemic angina or diphtheritis. 

He locates the cause of the development of the malignant angina in the stomach ; 



184 Bibliographical Notices. 

here the first impression of the disease is made, and is thence transmitted to the 
organs of respiration and deglutition. 

It is worthy of remark, that Aretseus recommends during the inflammatory 
state of tliis malignant disease, venesection, cataplasms, clysters, cupping. Sec. 
and that it is only in the second stage, when the first indication is fulfilled, that 
he advises the use of astringents, such as alum and honey, gall-nut, oxyde of 
zinc, and wild pomegranate, to the posterior parts of the mouth. 

The cause of the malignant, gangrenous, or diphtheritic angina, is to be 
traced to the presence of cold humidity, or putrid marshy exhalations, which, 
like the contagious emanations of typhus, or the miasm of variola are absorbed 
by the skin and mucous surfaces, and being transmitted to the visceral centre, 
exert their action primarily on the lining membrane of the stomach and small 
intestines, to which succeeds the diphtheritic phlegmasia. 

Now, if we recall the characters of croup, properly so termed, and compare 
the manner of attack in his disease with that of diphtheritic angina, we shall be 
naturally led to the conclusion that these two affections ought not to be con- 
founded. In fact, the angina maligna always succeeds to a gastro-enteritis, but 
croup has its origin in the larynx. In the first instance, the local bleeding ought 
to be from the epigastrium, in the second from the larynx. The epidemic an- 
gina, when it has not been properly combated by leeches to the epigastrium, or 
abundant and repeated venesection, will not be arrested by leeches to the throat, 
and some practitioners think it accelerates the fatal termination, which cannot 
be the case with croup; thus our author proceeds to draw a marked line of dis- 
tinction between the two diseases. 

Ji general description of the disease principally occupies the section to which 
we shall now proceed. 

The pellicular or diphtheritic angina is always consecutive to a gastro-enteritis ; 
it constantly appears as an epidemic, and consequently results from a general 
cause acting upon a greater or less considerable number of individuals subject- 
ed to its influence. We have seen, says our author, that a humid atmosphere 
charged with gas or marshy and fetid emanations, has been considered both by 
ancient and modern writers, as the cause of angina maligna; and we have also 
seen that these putrid emanations absorbed and carried into the digestive pas- 
sages, occasion there a true miasmatic poisoning, as in typhus: hence the pri- 
mary symptoms are those of a gastro-enteritis more or less intense. The patient 
has rigors, and an indefinable uneasiness, nausea, and vomiting, with or with- 
out pain of the epigastrium; the tongue is red at its borders and apex, and it is 
more or less coated at the base. This state continues sometimes two or three 
days before the signs of an invasion of the other mucous membranes are observ- 
ed; but sometimes also the transmission is more prompt. The dysurla and the 
soreness of the throat take place in a short time; the tonsils, the pharynx, the 
palate, and the nasal fossae become red; a whitish coating begins to appear, takes 
a colour varying from gray to brown, acquires consistence, and may extend 
itself to the larynx and bronchia, producing suffocation. This disease mora 
particularly attacks children, young girls, and women, but may also assail even 
robust men. 

It is remarkable that at the same time this affection occurs, we see epidemic 
fevers arising from the same general causes, prevail, and establish by their pre- 



Bibliographical Notices. 185 

sence and the uniformity of the symptoms at the commencement, the identity of 
these diseases. 

The treatment is begun by an abundant capillary bleeding" from the epigas- 
trium by means of leeches, to be repeated if deemed necessary. AVhen leeches 
cannot be procured, venesection should be practiced, and repeated from the 
first to the second day after the attack; later than this, they will be inefficient, 
and even dangerous, accelerating the fatal catastrophe, as in the application of 
leeches to the throat at a late period of the disease. This may explain the 
failures experienced by Marteau d'Aumale, Bretonneau, and all who have had 
recourse to this remedy too late. To this cause we may also impute the want 
of success, complained of by Ramazzini, in the epidemic of 1690, a fever, in 
which from the fourth to the seventh day, a petechial eruption developed itself 
at which epoch, venesection was always fatal, whilst a popular remedy, the 
scarificator and cups, applied when the lassitude, pain in the limbs, and vomiting, 
announced the invasion of the disease, without consulting tlie physicians, contri- 
buted to effect a cure, and indeed their application was followed by extraordi- 
nary success. 

At the same time we fulfil this primary indication, (leeching or venesection,) 
diluent drinks, emollient clysters, and the pyrothonid gargles are to be em- 
ployed. When the disease has progressed, whether it has been combated by 
opportune, general, or local bleeding or not, the nitrat of silver in solution, and 
even in the second or third stage, stimulating the fauces with alum or diluted 
hydrochloric acid may be resorted to. *' But," says our author, *' I repeat, they 
will always be superfluous, if at the beginning the gastro-enteritis be combated 
by leeches to the epigastrium, or repeated general bleedings." 

From what has been stated by Dr. E. of which the foregoing is but a brief 
outline, he comes to the following conclusions: — 

1st. That the malignant, gangrenous, or diphtheritic angina, is always epi- 
demic. 

2d. That it is caused by the absorption of putrid miasmatic emanations, and 
their action on the mucous membrane of the digestive passages. 

3d. That this lesion is indicated by all the signs of acute gastro-enteritis; that 
this phlegmasia is susceptible of a more or less rapid extension towards the 
throat, and it is only in this case that the angina exists. 

4th. That when properly treated, it never extends to the larynx, so as to pro- 
duce suffocation; so that the croup of M. Bretonneau is always the effect of negli- 
gence. It has no other resemblance to croup, properly so called, than the deve- 
lopment of a membraniform concretion in the air passages; the etiology, mode 
of invasion, progress, and the different treatment required by the two diseases, 
repels all the idea of identity. 

5th. That if there be any class of affections to which we can refer this disease, 
it is the typhus and epidemic gastro-enteritis. Since these, (as he has witness- 
ed,) can terminate by a pelhcular angina; they also have the same etiology, 
mode of invasion, and development, requiring also the same treatment. The 
same may be said of the epidemic cutaneous phlegmasias. 

6th. That it would be more correct to apply to this disease the name of gas- 
tro-entirite angineuse. 

The remainder of the volume is occupied with a critical analysis of an essay, 

No. XL— May, 1830. 17 



186 Bibliographical Notices. 

by M. Suchet,' in which acute or convulsive asthma is stated to have affected a 
number of adult females, though our author considers them as cases of hysteria; 
they are not of sufficient interest to require a further ijotice. 

C. B. M. 



XIV. Tahulas Anatomico-Pathologicx modos omnes quihus partium Corporis Hu- 
mani Omnium Forma Externa Mquae, interna d normd recedit, exhiheatis. 
Auctore J. F. Meckel Fasc. primus cum Tab. CEn. viii. Lipsize, 1817. Fasc. 
secund. Tab. viii. 1820. Fasc. tertius, Tab. ix. 1822. Fasc. quart. Tab. 

viii. 1826. 

The author of the work before us has long been known as one of the most 
distinguished anatomists of the age, and has, by the great ability of his nu- 
merous works, amply established his claim to this exalted station in the scale of 
public opinion. Descended from ancestors famous for their great proficiency 
in anatomy, he has by his diligence, and a mind truly philosophical, contributed 
more, perhaps, to the elevation of that department of science, than most of his 
predecessors or cotemporaries. The Archives der Physiologie^ edited at first by 
the celebrated Reil, and over which the author himself has now the controul, 
constituted the principal vehicle of his numerous early contributions to anato- 
mical science; and in these, as well as in his Beytrageder Menschlichenund Ver- 
gleichenden Jinatomie, we find developed the elements of those truly philosophi- 
cal principles which his subsequent labours have so successfully applied and 
unfplded. But the works that have contributed most to establish his reputa- 
tion, are his Handbuch der Pathologischen Anatomic, 3 vol. Leipsic, 1812-1818, 
his work De DupUcitale Monstrosa commenfarius, 1815, Dcscriptio Monstrorum 
Nonnullorum cum Corollariis Anatomico-Phys. 1826, Handbuch der Menschlichen 
Anat. 4 vol. 1815-1820, Systeme der Vergleichenden Anatomic, now in the course 
of publication, of which five volumes have appeared, and the Tabulae Anatomi- 
co-Pathologicae, before us. Of the several works enumerated, it is not for us to 
speak at present; the public voice has already procls^imed their merit, and we 
can only say, that we think the work last mentioned is well calculated to sus- 
tain the high reputation the author has already acquired. 

It will be seen by a reference to the heading of these remarks, that the first 
fasciculus, containing eight copperplates, was published as early as 1817. The 
work was indeed announced as early as 1815, in the preface to the Dissertation 
on monstrosities, and from the date of the appearance of the first fasciculus, one 
has been published at intervals of from two to three years, up to 1826, at which 
time the fourth and last fasciculus made its appearance. Some time, we fear, 
must yet elapse before it can be completed. We sincerely trust, however, that 
the design expressed by the author, of representing by engravings, the princi- 
pal anormal departures of the organization in its external and internal form, 
may not be relinquished, since such a work, when completed, will not only 
afford an invaluable treasure to the profession, but will constitute an almost in- 
dispensable appendage to the author's Handbuch der Pathologischen Anatomic, 
which it will be well calculated to illustrate. The value of the delineations of 
Sandifort, Baillie, Farre, and others have long been highly appreciated, and those 
of Professor Meckel, we feel assured, cannot fail to secure a still higher mark 



Bibliographical Notices. 187 

of public approbation, since, instead of being" representations of only a part of 
the abnormal conditions of the organs, they are intended to afford an exposi- 
tion of almost every known departure of the organization from its natural con- 
dition; therefore supplying an important desideratum in pathological anatomy. 

The first fasciculus is devoted to the delineation of the various important mor- 
bid conditions of the heart. The greater part of the figures present a high 
degree of interest, inasmuch as they are not drawn alone from cases which 
have fallen under the author's own observation, but from the most interesting 
examples of the disease in question, which exist on record. In representing 
the different anormal conditions of the external configuration and internal ar- 
rangement of the heart and great vessels, Professor Meckel has not only furnish- 
ed us with some very important examples of a departure from nature in these 
particulars, but has fully confirmed the truth of a proposition long since laid 
down by him; that such deviations approximate to the natural type of the same 
organs in some of the lower orders of animals. This is particularly exemplified 
in those figures which represent a free communication between both auricles 
and ventricles through their septum, thus representing the general type of the 
single heart of some animals. 

The second fasciculus embraces the consideration of some of the alterations 
of form and texture to which the arteries are liable. Several figures are de- 
voted to the anomalous distribution of some of the principal arteries, and fur- 
nish some very unusual and interesting deviations of that class. The most va- 
luable plates, however, contained in the fasciculus, are those devoted to the 
subjects of aneurism, dilatation of the aorta, and the various alterations of tex- 
ture which implicate the tunics of the vessels. All these subjects are deline- 
ated with much ability, and some very important examples of the several con- 
ditions enumerated are exhibited. 

The succeeding fasciculus, with the exception of the first plate, which re- 
presents some morbid conditions of the jaws and teeth, is devoted, for the most 
part, to some of the primitive vices of conformation which are met with in the 
digestive organs. Some very curious anomalies of the pliarynx, oesophagus, and 
stomach are represented. Amongst numerous other anomalies contained in 
this fasciculus, we observe several examples of diverticuli of the intestines, 
some of these very curious. 

The fourth and last fasciculus that we have received, presents much more of 
practical interest than either of the preceding, since it embraces the consider- 
ation of intussusception and hernia. The most important pathological conditions 
that fall under these heads are admirably delineated, furnishing excellent ex- 
emplifications of the character and consequence of intussusception, as well as of 
the principal varieties of hernia, as inguinal, crural, umbilical, diaphrag- 
matic, 8cc. 

The tables of Professor Meckel are executed with great neatness and care, 
and are well calculated to preserve the several morbid appearances, the recol- 
lection of which they are designed to perpetuate. At the present period, es- 
pecially, when pathological anatomy is made to constitute the very ground- 
work of the science of medicine, coming, as they do, from a source so re- 
spectable, and abounding with the most interesting materials, we think these 
tables must be hailed by every one, as an invaluable acquisition to the science, 



188 Bibliographical Notices. 

and that all must cordially respond the wish expressed by ourselves, that the 
distinguished author will continue his labours in a cause fraught with so much 
usefulness, and complete his design so laudably undertaken. E. G. 



XV. De la Destruction Mecanique de la Pierre dans la Vessie,- ou Considerations 
Nouvelles sur la Lithotritie. Memoire lu d Vlnstitut, &c. Par J. J. A. RIgai, 
Paris, 1829, 8vo. pp. 97, plates III. 

Improvements in the surgical art, particularly those of a mechanical nature, 
would, we might suppose, very soon assume their proper position in public 
opinion; since the evidence which in such cases is derived from our senses, 
must generally prove decisive. But, if a new operation of such tangible quali- 
ties, that its feasibility or impossibility — its value or Inutility, ought readily to 
be ascertained, did nevertheless continue to divide medical opinion, even grant- 
ing that facts were advanced on both sides, should we not rather incline to co- 
incide with those, who prove the thing actually to have been accomplished, 
than with others, who having failed in their attempts, resort to reasoning to 
prove it impracticable? 

Such appears to be the case with the operation of lithotrity, nor as yet, do the 
parties of either side seem disposed to yield the point to the other. There be- 
ing but one right side to a question, and only one true inference to be drawn 
from a simple fact, it is natural to suppose that circumstances entirely foreign to 
the subject, must occasionally exert an influence in producing a diversity of 
sentiment. It is not necessary, however, here to enumerate the circumstances, 
that, with different individuals, and for various reasons, might occasionally have 
brought forward arguments against the operation, now so successfully practised 
by Messrs. Civiale, Heurteloup, and others. Our present object is of a very dif- 
ferent nature, being, as we hope, an unbiassed review of the labours of one 
who merits all he asks — impartiality. 

The zeal so peculiar to the French nation, seems to have been aroused to an 
unusual degree, on the subject of hthotrity, and for some years past, astonish- 
ing improvements in the instruments employed, have resulted from the inge- 
nuity of those, who have engaged in the undertaking. 

The favourable report made to the Academy of Sciences, by Messrs. Boyer, 
Serres, Flourens, Magendie, and Dumeril, appointed to examine the memoir 
and instruments of Mr. Rigal, has placed him high among the aspirants to fame, 
and induced us to present to the medical public an analysis of his views, with 
some account of the instruments he has described. 

Mr. Rigal divides his memoir into three parts. In the first he considers cathe- 
terism by straight instruments, and the means by which to overcome the obsta- 
cles that sometimes prevent their employment. 

The difficulties opposed to a general adoption of lithotrity for the destruction 
of urinary calculi, are still numerous, notwithstandmg all that has been done to 
obviate them; one, and not the least important of these, has particularly excit- 
ed the attention of Mr. Rigal, and indeed first induced him to enter into the in- 
vestigation of this subject. We refer to circumstances connected with the ure- 
thra alone, preventing the success of the operation. " This inconvenience may 
arise from various causes: eitherthe extreme sensibility of the urethra with some 



Bibliographical Notices. 1S9 

subjects — or the too great curvature of this canal, with others, or from an en- 
largement of the prostate gland, and especially of its third lobe. A considera- 
ble number of patients being placed in some one of these conditions, would be 
obliged to forego the advantages of lithotrity, effected by the employment of 
straight instruments, if, by some means, a sound of this form were not made to 
penetrate into the bladder." Such means, Mr. R. has discovered, and put in 
execution. A case occurred to Mr. Leroy, in which \a curved sound entered the 
bladder with the greatest facility and detected the presence of a calculus of mo. 
derate size; "but," (we quote his own words,) "when I wished to introduce 
the straight sound, it was impossible to succeed — &c. I procured a large gum 
elastic catheter, in which the straight sound entered with facility; I next had 
made a curved ii-on staff, which exactly filled the catheter, and whose rounded 
extremity formed a beak. I proposed first to introduce the large catheter, to 
withdraw the curved staff, and then to pass the straight sound in its place. The 
large catheter and its curved staff entered with facility, but when, upon having 
withdrawn the staff, I attempted to introduce the straight sound, I experienced 
an insurmountable resistance." 

Upon examination per rectum, he discovered an enlargement of the prostate 
gland, which had been the cause of a retention of urine, and produced the fail- 
ure in his attempts to introduce a straight instrument. 

Mr. Rigal accounts for the want of success in this case, by supposing that 
** the g-um elastic catheter had impressed a greater permanency, (une fixite 
plus considerable,) to the curvature of the urethra, and then the vesical extre- 
mity of the straight sound, striking against the inferior curve of the factitious 
canal, became there arrested by an insurmountable obstacle. I was certain of 
having discovered the means of overcoming this, in employing the sound I am 
about to describe." 

Instead of moulding his gum elastic catheters, or bougies, upon a straight po- 
lished rod, as generally practised, he caused that extremity of the rod or sound 
which was to correspond with the vesical end of his bougie, to be cut in the 
manner of a male screw, for the space of about three inches and a half, the ave- 
rage length of the curvature of the urethra. Upon this screw was wound a piece 
of thin, softened iron wire, in such manner as to fill up the grooves of the screw 
to the level of the shaft of the sound. Thus prepared, this sound became the 
model upon which was wrought the silk net-work, &c. required to form a flexi- 
ble catheter — the straight staff to the catheter being- the rod, on which it has 
been formed. This being withdrawn, a curved sound was introduced in its place, 
and the instrument thus prepared, passed readily along the curve of the urethra 
into the bladder. The curved sound is then taken out, leaving the gum elastic 
catheter in the urethra. The next object is to reduce the curvature or obstruc- 
tion in that canal, in order to facilitate the employment of straight instruments; 
to effect this, the straight staff is now introduced through the catheter, and by 
turning it as it advances through the screw, the curvature of the urethra is gra- 
dually overcome, until at length reaching the bladder, the whole instrument be- 
comes perfectly straight, consequently the urethra also. By this means, Mr. R. 
hopes in time, so to overcome the obstacle, as to permit the employment of 
straight instruments, and even suggests, that a catheter of this construction. 



190 Bibliographical Notices. 

might be made large enough to admit instruments for the destruction of a cal- 
culus at once. 

It will probably be suggested, that the utility of this instrument, Ingenious as 
it is, must depend, in a great measure, upon the benefit to be derived from li- 
thotrlty itself, to which it is only intended to be preparatory. Possibly, how- 
ever, in cases where retention of urine arises from an enlargement of the third 
lobe of the prostate gland, a degree of pressure might be exercised, by convert- 
ing a curved catheter into a straight one, sufficient to remove the obstruction, 
and also, in some cases of stricture, it may prove beneficial; as, for example, 
where the urethrals thickened for some space, when a straight instrument would 
exercise more pressure than a curved one. 

In the second division of his memoir, Mr. R. presents us with an analysis of 
the various instruments recommended for the destruction of urinary calculi. He 
compares the practice of Mr. Civiale, (which consists in boring a hole, then 
loosening the hold of the calculus, to catch it again in a different position, and 
thus finally break it up,) with that of Mr. Heurteloup, who having once caught 
the calculus, does not leave it until it is excavated so as to form a hollow shell, 
easily broken up. 

The objections which Mr. R. rather unnecessarily advances to these opera- 
tions in succession, seem to have no other object than to prepare the reader for 
his own, a detailed account of which follows, and forms the subject of the third 
and last section. Having thus completely cleared the ground for the erection 
of his own pretensions, he starts with the principle, to use the words of Mey- 
rieu, his cotemporary and coadjutor, '*that nothing beneficial will be effected 
in lithotrity, so long as we attack the calculus from the circumference to the 
centre, as generally done, instead of destroying it from within outwards." Ob- 
jections, however, are suggested as applicable to the instruments of Mr. Mey- 
rieu, not necessary to dgtail here, to obviate which becomes his next object. 
On this point, after much labour, and successive improvements in the instru- 
ments, he offers the following reflections as the result. 

"Is it not true, that if we could succeed in fixing a calculus firmly upon the 
drill, which had penetrated it, we might continue to set the calculus in motion, 
and destroy it by friction against the branches of the forceps, to which the ope- 
rator would allow sufficient expansion, to favour the rotation of the body he 
wished to destroy? The forceps would first furnish the means of seizing the 
stone, and then become a kind of file, in the second stage of the operation. I 
did not fail to remark that these forceps being formed by a cylindrical tube, di- 
vided into three branches, each one of them ought to have on its internal face, 
and near the sides, two projecting edges. 1 had nothing therefore to change in 
this particular, and I observed six sharp angles, running the whole length of 
the blades, as inoffensive to the bladder, as well calculated to grind off the 
stone when applied to them." 

It was necessary in the first place, to endeavour to enlarge the head of the 
drill, after it had effected an opening into the calculus, and to cause it to re- 
main firmly fixed within the interior. To accomplish this, was contrived the in- 
strument next to be described. 

A steel drill, terminating in a spear-pointed head, is enclosed in a tube of the 



Bibliographical Notices. 191 

same metal, whose vesical extremity is divided into two or three blades or 
prong-s, which by their elasticity closely embrace the shaft of the drill. The 
head of the drill projects beyond these blades, thus forming- an instrument, by 
which the stone may be perforated, the blades entering the perforation, at the 
same time, as if they formed a constituent part of the drill; this accomplished, 
the projecting head of the drill is to be drawn within the blades, by which they 
are expanded, and the stone firmly held; an idea of this instrument maybe ob- 
tained by comparing- it to a common round trocar. The blades being- sharp and 
angular, on their outer faces, it is proposed, by working them forwards and 
backwards, in the perforation, to form small grooves in the calculus, accommo- 
dating them, thus making their hold upon it more firm and secure. The instru- 
ments just described are enclosed within a tube, whose vesical extremity consti- 
tutes the three-bladed forceps, calculated for seizing the stone, and are similar 
to those of Messrs. Civiale, Leroy, &c. with this addition only, that they pre- 
sent sharp ridges along their inner edges. The whole is embraced by the outer 
tube, as in the other instruments now in use. 

The most essential difference, therefore, which is to be noticed between this 
instrument of Mr. Rigal, and those heretofore employed, consists, first, in his 
having one extra tube, which closely embraces the drill, and is expanded when 
the head of the drill is drawn within it; and secondly, in the forceps being com- 
petent to grind a stone, as well as to seize it. The operation then would con- 
sist, first, in catching the stone, and penetrating it with the drill in the usual 
manner; secondly, in securing it in such a way upon the drill, that, as our au- 
thor remarks, they may form but one body; thirdly, in relaxing the blades of 
the forceps, so as to allow unimpeded motion to all within them; and lastly, by 
rotating the drill, and consequently the calculus attached to it, to grind off, or 
wear away the stone, against the sharp edges of the forceps. This part of the 
operation, he prefers, accomplishing, by an arrangement different from the bow 
and pulley usually employed. The drill is fixed into a small wheel with oblique 
cogs, acted upon by a horizontal wheel, six times its diameter, thus making one 
revolution of the latter equal to six of the former. The larger wheel is turned 
by a handle. The advantages proposed to be gained by this suggestion, are, 
that the rotation is more rapid and more equable; the irregularities of the cal- 
culus, if there be any, are, as in the turning lathe, more easily ground off; and 
the operator can, with more precision, ascertain the degree of resistance offer- 
ed to the process, so as to graduate the force by which to apply the blades of 
the forceps against the stone. 

This, which may be considered as the first principle of the operation, would, 
we are ready to allow, be competent to the destruction of the greater part, or 
nearly the whole of a calculus — provided it be not beyond a certain size, and be 
not flat in shape. That portion which remains on the drill, is to be broken into 
fragments, by the forcible expansion of the instrument holding it, and this con- 
stitutes the second principle of Mr. R.'s invention, He asserts that calculi, even 
of considerable size and solidity, are broken with astonishing facility, by this 
application of an expanding power, acting from the centre to the circumfer- 
ence; and to the discovery and application of this fact, he attaches most impor- 
tance, in which however we are not disposed fully to coincide with him. Mr. R. 
has subjoined also, the description of what he terms " a desk bed. *' This consists 



1 92 Bibliographical Notices. 

of a portable box, which upon being" opened and unfolded, furnishes inclined 
planes, attached by joints, calculated to accommodate the patient, and to place 
him properly for the operator, and which may be arrang-ed upon any common 
table. 

Mr. Rigal's sug-gestions, which seem to have been progressive, have in our 
opinion, led him a step too far; he is disposed to neglect the first principle of 
his operation entirely, and proposes hereafter, to break up a calculus, by the 
expanding power only, catching the larger fragments, and treating them in the 
same way as he had the original stone. This is all very well in theory, and 
equally easy to accomplish upon the dead subject; but he forgets that the catch- 
ing a foreign body in the bladder, is decidedly the most difficult, most painful, 
and most hazardous part of the operation, and therefore he talks of *^ seizing 
fragments,'* as if it were always an easy task, and quite an indifferent matter to 
the patient. Decidedly the most important and effectual plan of effecting li- 
thotrity, will ultimately consist, in catching a calculus but once, and then'to 
complete its destruction. 

The more minute mechanism of these instruments is much too complicated, 
for us to attempt any explanation, unaccompanied by plates to illustrate them. 
The principal features, we trust, are sufficiently delineated, to render that jus- 
tice to Mr. R.'s pretensions, his ingenuity and perseverance so well merit. 

J. P. H. 



Art. XVL Ueberdie Verletzungen des Rueckmmarkes, in Hinsicht aufihr Lethali- 
taets-Verhaltniss. Von Dr. John Ludwig CASPEii,PractischemArzte in Berlin, 
Mehrer gelehrten gesellschaften Mitgliede. Berlin, 1823. 

This is a highly interesting memoir upon the subject of which it treats — in- 
juries of the spinal marrow considered in reference to their comparative fatality. 
Upon the questions involved in the discussion, there has always existed consi- 
derable diversity of opinion; some affirming that all wounds of the spinal mar- 
row are necessarily fatal, while others have brought forward examples of such 
injuries in which recovery has taken place even under the most unpromising 
circumstances. It is certainly a subject of great interest, whether considered 
in a pathological or medico-legal point of view, and we are much indebted tO' 
the author for the t^ent and diligence he has evinced in travelhng over the 
whole grounds, and drawing such conclusions as seem to be warranted by a ma- 
ture and dispassionate examination of the subject in all its bearings. 

Injuries of the spinal marrow are divided by Dr. Casper into three orders: — 
Wounds, Compression and Concussion. These are Subdivided as follows: — 

*' A. Wounds. 1, Punctured; 2, Incised; 3, Contused; and 4, Poisoned 
wounds. — B. Compression. 1, From luxation of the vertebra; 2, Fracture of the 
vertebra; 3, Foreign bodies introduced b)'' wounds of the vertebra so as to com- 
press the spinal marrow; 4, From fluids thrown out, either by a preternatural 
exhalation or secretion, or extravasation occasioned by wounds. — C. Concus- 
sion. 

The author, after considering the various modifications of these several spe- 
cies of injury, arrives at the following conclusions, which, as general rules, are, 
we think, sufficiently correct. 



Bibliographical Notices. 193 



IwjuEiES Absolutely Fatal. Injuries not Absolutely Fatal. 

1. ** Punctured wounds implicating; 1. " Punctured wounds of the lower 
the upper portion of the spinal mar- portion of the spinal marrow. 

row. 

2. "Incised wounds of the same 2. "Incised wounds of the same, 
part. 

3. "Laceration of the entire thick- 3. "True dislocation of the dorsal 
ness of the upper portion of the spinal and lumbar vertebra. 

marrow. 

4. '' True dislocation of the cervical 4. "Fracture of the spinous pro- 
vertebrae, cesses of the vertebra. 

5. " A preternatural collection of 5. " Concussion of the spinal mar- 
fluid within the spinal canal." row." 

Exceptions to these conclusions will, doubtless, occur in some cases, yet we 
consider them sufficiently accurate as general rules, and as such we think they 

possess considerable value. E. G. 



XVII. Precis Analytique et Raisonne du Systeme du JDodeur Gall Avec figures, 
4e Edition. Paris, 1829, 12mo. pp. 248, pi. XVII. 

In the French capital, the present head quarters of medicine, every subject 
embraced by that science is now presented in the form of summary or manual. 
Indeed some such labour-saving contrivance seems absolutely necessary, since 
from the zeal and assiduity with which investigations are prosecuted, the increas- 
ed number of authors and consequent multiphcation of writings, we do not well 
see how one could otherwise keep pace with the periodical and other literature 
of the day, even should he have no other occupation thanreading. In the small 
treatise before us, the plan has been applied to phrenology, and as it may gra- 
tify some of our readers to know what are the doctrines now promulgated 
abroad, we shall take advantage of the recent publication before us, to present 
a concise view of them. 

The anonymous author represents himself as a pupil of the late Dr. Gall, 
whom he pronounces the most remarkable savant of the present epoch, invok- 
ing his manes to smile upon his efforts, and receive them as the expressions of 
his highest admiration and sincere gratitude. By the by, such indications of en- 
thusiasm should put us on our guard, since we hold that the representations of 
no one under the influence of a high degree of this feeling, are to be entirely 
trusted. Previous to its first appearance, the summary was submitted by the 
pupil to his master, who not, only approved of its doctrines, but recomm.ended 
its pubhcation as calculated to render these more popular, a result which seems 
to have been answered, inasmuch as in Paris it has already gone through four 
editions in the space of about two years. The objects contemplated by phre- 
nology, are, in fact, above all others, calculated to excite popular curiosity. 

Since the date when Gall and his coadjutor first promulgated their system, one 
might think sufficient time had elapsed to allow its truths to be clearly demon- 
strated or its fallacies fully exposed. As yet, however, it cannot be said that either 
decision has been positively established, and in this country at least, the number 
is not great of those who are prepared to express unqualified behef in the sys- 
tem. The author of the manual before us seems likewise under some restraint 
in the expression of his faith, and sends forth his book without his name. Isthis 



194 Bibliographical Notices. 

condition of doubt and uncertainty owing* to original error, to the resistance of 
prejudice, or the want of still further investigation? The perplexities involved 
in the systems of metaphysics, should certainly dispose us to give a patient con- 
sideration to any plan which might possibly tend to lessen them. Those, there- 
fore, we think inexcusable, who from prejudice or any other motive, treat the 
system of Gall as altogether an idle vision, unworthy of serious consideration. 
That he has indulged in some extravagancies, his warmest advocates, must we 
think, admit; but this might naturally be expected from the enthusiasm with 
which he pursued the subject of his investigations. We would not, however, 
entirely reject them on this account, since, should it turn out that he has really 
done less for metaphysics than was anticipated, we must still acknowledge our- 
selves under considerable obligations for the hght he has shed upon physiology 
and pathological anatomy. 

The Precis commences with a preliminary discourse of considerable length, 
in which a glance is afforded of the several systems applied by the most cele- 
brated philosophers, both ancient and modern, to explain the psychology of 
man. It is well known, that the ancients were in possession of comparatively 
few facts in relation to the laws of nature, the elements and properties of mat- 
ter, and especially the more minute divisions of animal organization. Their 
small stock of-positive knowledge was blended with innumerable errors, natu- 
ral results when fertile imaginations are abandoned to conjecttire, a course, 
which, in their search after the essence of the intellectual faculties, led them 
into abundant metaphysical difficulties. In regard to modern authorities of most 
weight, such as Locke, Descartes, Condillac, Kant, &c. he ingenuously acknow- 
ledges that they are not absolutely incapable of affording some useful instruc- 
tion, but at the same time he aims at rendering them entirely nugatory, by ad- 
vancing as an axiom, that it is impossible to comprehend or explain the moral 
and intellectual part of man, without having previously studied him physically. 
Casting aside therefore all abstract notions, he considers anatomy and physiolo- 
gy as alone capable of laying the true foundation of metaphysics, and looks upon 
it as the crowning merit of Gall, that he was the first who dared to bring the 
philosophy of man to these conditions. 

In tracing out his system of the internal forces or powers which determine 
and regulate the actions of man, a system intended utterly to subvert all those 
by which it has been preceded, our author proceeds from the most simple to 
the most complex, noticing in the first place, those which result immediately 
from the mechanical or physical action of organs and the properties of the tis- 
sues composing them. These are out of the immediate influence of the will, 
and are called automatic actions; among which are, the motions of the heart, ar- 
teries, veins, ventricles of the brain, intestines, together with all the functions 
constituting what is called vegetative life, or life of nutrition. 

Immediately above these actions, come that series of sentiments designated 
by the term necessities, seated principally in the organs oi automatic life. Hun- 
ger, thirst, respiration, &c. belong to this second order. All internal forces of 
this kind, with which we are acquainted, imperiously oblige us to act upon the 
external world. 

In the third order are the instincts^ which may be defined, certain unreflect- 
ed internal forces, impelling to the performance of particular acts necessary to 



Bibliographical Notices. 195 

our existence, which acts, though executed by voluntary motions, are more or 
less irresistible. 

The passive functions of sense, should, our author thinks, form a fourth or- 
der, and their active functions a fifth. As examples of the first he mentions, the 
impressions of light upon the eyes, sound upon the ears, and cold upon the skin, 
over which he says we have no more controul than we have over the instincts. 
But it is different when these impressions induce attention and volition, and in- 
volve moral responsibility. 

After the active functions of sense, may be placed the voluntary movements^, 
such as those of the limbs, serving for locomotion and the exercise of other 
acts connecting us with the external world, through the agency of muscles im- 
mediately under cerebral influence. 

In the seventh order come the propensities^ which are internal forces impel- 
ling us more or less imperiously towards particular objects, and to view and re- 
ceive things in a certain manner. These exert a powerful influence over the 
conduct of man and other animals, but are liable to be greatly modified by the 
combined agencies of superior faculties, by education. Sec. Physical love, at- 
tachment, or friendship, the dispositions to quarrel, provide, 8cc. belong to this 
order. 

In the eighth order, our author places those instincts to which Gall has ap- 
plied the term aptitudes industrielles, exemplified in the skill displayed by the 
spider in forming its net, as well as that shown by the beaver and by birds in 
their respective buildings. Such aptitudes he regards as distinct from instincts, 
properly so called, since they indicate a degree of Intelligence. 

In the ninth order we have the intellectual dispositions or mental faculties, by 
the agency of which notions and ideas of things are acquired. The combination 
of these constitutes that particular faculty called reason. 

Next come the moral qualities, which result from the application of the intel- 
lectual faculties superior to the direction of the propensities mentioned in the 
seventh order. 

Finally, that no internal cause capable of influencing the determinations of 
man, may be omitted, two others must be noticed; namely, the preponderance 
of certain systems of organs over the others, giving rise to what are styled tern- 
peraments; and those derangements which may take place in the functions of 
automatic life, as well as those in the life of relations. These two new orders 
of causes are the more efficient, inasmuch as they exert a more immediate and 
universal influence over all the others. The propriety of constituting a new or- 
der out of the derangements of functions, may be fairly questioned. 

These, then, our author tells us, are the principal internal causes, which, in- 
dependent of any such abstractions as pure conceptions, ideas a priori, forms 
of sensibiUty, &c. concur in the production of our thoughts and actions, and to 
which may be referred all the differences of humour or character which we re- 
mark among men. 

He proceeds next with some observations relative to the principal external 
causes, contributing to the development of man, by exercising over his inte- 
rior forces a greater or less influence, which he divides into primitive or natu- 
ral, and into secondary or accidental causes. Soil, climate, and the aliments con- 
stitute the first, government, religion, and philosophy the second. 



196 Bibliographical Notices. 

After this view of the combined forces operating" upon man, we shall pre- 
sent a coup d'oell of the laws of the cranium or cranioscopy, a term which our 
author prefers to either organology or craniolog-y. 

"We are informed by Gall that he was gradually led by observation into the 
belief, that the dispositions and character of individuals were in conformity with 
certain external cerebral developments, and that he was thus induced to found a 
new physiology of the brain His new views were, he tells us, subsequently con- 
firmed by the following pathological phenomenon. He had been taught to be- 
lieve that in dropsy of the brain, a dissolution of its substance took place. This 
however he could not reconcile with the observation he had made, that the in- 
tellectual faculties were not always destroyed in this disease; and supposing, 
therefore, that there was some mistake in the pathology, he determined to as- 
certain if possible the truth of the matter. 

A hydrocephalic woman, whom he had attended, and who had bequeathed 
to him her head, furnished an opportunity of satisfying his doubts, and at the 
same time of demonstrating that the brain is of a fibrous structure in its white 
part, and not merely a simple agglomeration of globules, as it was formerly con- 
sidered. This woman, who had preserved the integrity of her Intellectual func- 
tions till death, had nearly four pints of water in her cranium, and the species 
of maceration to which the brain had been subjected, allowed Gall to unfold, as 
it were, the circumvolutions of which It Is composed, and at the same time to 
exhibit to the eyes of his pupils the fibrous texture of their parenchyma. 

Pursuing his investigations, he showed subsequently that the gray substance 
of the brain is of a gelatinous nature, whilst the white consists of very delicate 
fibres, forming a sort of skin or membrane reflected upon itself, the folds con- 
stituting the circumvolutions which we observe upon the surface of the brain; 
that these circumvolutions are the seat of the superior faculties, by means of 
which man can compare, associate, and judge of the various impressions he re- 
ceives, and deduce the consequences. 

In establishing the four fundamental principles of his system. Gall laid it 
down as the first, that the propensities and faculties of man and other animals 
are innate. 

Considering in the next place that the aptitudes, intellectual faculties, and 
moral quahties are varied by numerous material circumstances, he adopted as a 
second principle, that the exercise of our instincts, propensities, intellectual fa- 
culties, and moral qualities, are subservient to the influence of material and or- 
ganic conditions. 

Convinced by numerous facts furnished by human anatomy and physiology, 
as well as comparative anatomy, pathology, and natural history, that a grieater 
development of the cerebral organs favours and Increases the exercise of the 
intellectual and moral functions, he laid it down as a third rule, that the brain 
is the organ of all our instincts, propensities, sentiments, aptitudes, intellectual 
faculties, and all other moral qualities. 

An extension of this last principle, led him to the adoption of a fourth rule, 
namely, that each of our Instincts, propensities, sentiments, talents, and our in- 
tellectual and moral faculties, has In the brain a place specially appropriated to 
it, a determined seat; and that the development of each of these various parts, 
which form as it were so many little brains or individual organs, manifests itself 



Bibliographical Notices, 197 

upon the exterior surface of the head by signs or visible and palpable promi- 
nences, in such a manner, that from the examination of these protuberances by 
the sight or touch, the particular dispositions and intellectual and moral quali- 
ties of every individual may be ascertained. It is this fourth and last principle 
which has encountered the most incredulity and resistance. 

In the exposition of his doctrine, Gall further sets forth, that the faculties in- 
crease or diminish, as the organs which are their supposed seats, develope 
themselves or become stronger or weaker; that they are active and efficient in 
proportion as the same organs possess more strength and perfection, and in a 
word, in all their manifestations, offer aberrations and derangements analogous to 
those we remark in their respective organs. The brain, which in the first pe- 
riod of existence appears almost without consistence throughout, is observed to 
increase little by little in solidity, acquire a fibrous structure, and enlarge gra- 
dually until about ^he age of forty or forty-five, when it appears to have acquir- 
ed its full development. In this state of perfection, the organ rests some time, 
when its circumvolutions begin to sink, and it is observed to diminish insensibly 
in volume and elasticity, the faculties of which it is the seat losing at the same 
time their powers. Gall thought he had established as an incontestible fact, that 
all men who are distinguished for energetic faculties, or superior merit, have 
the front or some other portion of the head developed to an extraordinary de- 
gree, whilst on the contrary, those in whom the cranium offers but little capa- 
city, or exhibits irregularities in the projections, manifest a deficiency in pro- 
portion to the degree of deformity. He cites the case of a young man whose 
forehead had scarcely an inch of elevation above the root of the nose, who ma- 
nifested only those faculties situated near the eyes, being absolutely incapable 
of exercising any of those belonging to organs occupying the superior region 
of the forehead, that is to say, to compare, combine ideas, and form a judg- 
ment. In rickets, however, the common effect of which is to produce consi- 
derable development and irritation in the brain, the intellectual faculties of 
children are frequently more acute and active than comports with their age. 

According to Gall, each inclination and propensity arises from the action of a 
single organ. The will, on the contrary, is a decision resulting from the exa- 
mination and comparison of many motives, that is to say, the sum or result of 
many forces acting differently. Jhe explanation he gives of the various degrees 
of extension acquired by the will in the diflferent species of animals, in propor- 
tion as they are found endowed with organs of relation and more elevated fa- 
culties, is curious. He admits that the action of one organ cannot destroy the 
impression received through another, nor the action which is the necessary 
consequence, but pretends that, in proportion as the organs increase in num- 
ber, the individual, rendered susceptible of a greater number of sensations and 
ideas, experiences more of those powers which enlighten, and of inducements 
not to pursue blindly the gratification of this or that desire, or the impulse of 
a certain propensity. A sort of combat ensues between his inferior and supe- 
rior faculties, and in proportion as these last have acquired development and 
received cultivation, they almost always predominate over the brute propensi- 
ties. With the inferior animals in which the number of organs is very limited, 
the will is but a simple volition influenced by the irritation of this or that or- 
gan. In man, on the contrary, where the plurality of organs reaches its maxi- 
No. XL— May, 18S0. 18 



1 98 Bibliographical Notices, 

mum, the excitation falls at the same time upon several organs, when the coun- 
teracting forces immediately commence tlieir play. If for example, the destruc- 
tive instinct provokes to murder, benevolence or theosophy, equally excited, 
directs the attention of the soul upon other objects, and opposes the accom- 
plishment of the action. ' Thus in man the superior faculties with which he is 
endowed, their culture joined with other motives, furnished by education, the 
laws, rehgion, &c. constitute a superior power, which examines, compares, and 
^Weighs the motives of his actions, and impresses on them a greater or less de- 
gree of morality. 

So far as the osseous conformation of the head is concerned, there are but 
eight of the bones which:particularly interest tlie student of craniology, namely, 
those entering directly into the construction of the walls of the cranium, and 
composing the bony box which contains the brain. These, although usually de- 
scribed by anatomists as of the same form and structure, differ considerably in 
the eyes of the phrenologist, who observes in the various configurations they 
present, and tlie capacity of the space they include, so many indexes of those 
intellectual differences which exist between individuals. Connected with these 
investigations, is the important question, whether the brain always fills the ca- 
vity of the cranium so exactly, that one may in all cases infer from the form of 
one, the configuration of the other, or the respective development of its parts. 
The verity of craniology, in fact, rests upon the condition, that the external 
surface of the cranium offers precisel}' the impression of the elevations and de- 
pressions which exist on the external surface of the brain. Convinced of the 
necessity of this exact coincidence, Gall engaged himself to prove, 1st, that the 
form of the cranium depends upon a centrifugal action exercised upon it by the 
brain. 2d, That under the ordinary circumstances of life, that is to say, in a 
healthy state of the brain and of the individual, this viscus fills the cavity of the 
cranium in such a manner, tliat the form of this last is always the precise figure 
of the other. 3d, That no external circumstance, such as the cross positions of 
the head of the infant during delivery, or subsequent compressions produced 
by the practice to which some are subjected of carrying bmlhens upon the 
head. Sec. are capable of altering the form of the cranium, seeing tliat these ac- 
cidental circumstances could not resist the permanent and centrifugal action of 
the brain. Nothing but constant pressure could produce an effect analogous to 
the deformity which we observe in the cranium of the Caribs and some other 
people. According to Gall, it is the same with the form of the cranium as with 
the resemblance traced in the features of the countenance and the forms of 
other parts of the body; it is de4:ermined at the moment of conception, and the 
child is born with a tendency more or less decided to assume httle by little, the 
appearance of its parents. It is, moreover, difficult to determine the exact time 
when the definitive development of tlie brain takes place. 

The sinking or contraction of the brain consequent to its period of decline, 
does not, as some suppose, leave a vacancy between it and the cranium, since 
the internal table of this sinks in the same gradual manner, and continues to 
mould itself exactly over the convolutions, excepting only, tliat as the external 
table does not change, a spongy substance is deposited in the spaces between 
the lamina. Thus the bones of the cranium become more thick and spongy than 
at other periods of life. Gall thought that he had likewise proved by observa- 



Bibliographical Notices. 199 

tions made upon the human species, tog-ether with direct experiments upon 
animals, that misery, fasting", abstinence, bad treatment, and above all, food of 
a bad quality, or given in too small quantities, produce the same effects as old 
age, that is to say, a drying of the nervous system and subsidence of the brain, 
followed by a failure of the corporeal forces, as well as of the intellectual facul- 
ties and moral qualities, which may explain the degradation that marks the 
conditions of certain people. 

It would be altogether a vain task to attempt to point out the locality of each 
particular organ without the assistance of plates. For this reason we shall pass 
over organology, properly so called, and conclude this notice with a short bio- 
graphical and phrenological account of the founder of the science furnished by 
the treatise before us. 

Jean-Joseph Gall was born in 1758, at Tiesenbrunn, in Wurtemburgh, and 
died at Mont-Rouge, near Paris, in the summer of 1829. His father, who was a 
merchant, sent him whilst yet very young, to one of his uncles in the duchy of 
Baden, to commence his education. From this place Gall went to Strasbourg!! 
for the purpose of studying medicine, then to Vienna where he assumed the 
garb of the physician, which profession he practised up to 1805, wdien he left 
the last named city to return to his father, who had a desire to see him previous 
to his death, and also to make a tour in the north of Germany, where he com- 
menced teaching his new doctrine. Finally he arrived at Paris in 1808, where 
he continued till his death to devote himself to the. prartlr.e of medicine, and to 
promulgate the results of his laborious researches. 

From an attentive examination of the head of this celebrated man, who for 
intellectual capacity may be ranked with the first of the age, the author of the 
treatise before us, drew the following indications, namely: — among the organs 
most developed may be enumerated all those situated on the anterior and su- 
perior parts of the forehead, such as the spirit of induction, that of wit, the fa- 
culty of abstracting and generalizing, but above all, benevolence. On the crown 
and sides of the head, there were also strong developments of firmness or per- 
severance, caution and cunning, or rather finesse and ingenuity. The accusa- 
tion of duplicity with which he had been charged, our author regards as un- 
founded. The sexual appetite was strongly marked upon the occiput, whilst 
the anterior and inferior parts of the forehead exhibited small indications of the 
memory of facts and philology. Finally, colour, music, mathematics, mecha- 
nics, and especially poetry, were very faint, and this last sense to such a de- 
gree, that he actually had an antipathy for versification. All the other organs 
were in a state of ordinary|development. That of locality, which had appeared 
very prominent, was only a contraction of the skin, produced by the habit of 
thinking. 

To this cranioscopy must be added, a strong constitution, a degree of cor- 
pulence, and a stature considerably over the mean height. His movements dis- 
played more gravity and energy than lightness and promptitude, his looks much 
fixedness and penetration. His countenance was sometimes marked with care, 
and had generally an expression rather of seriousness than gaiety. Calm and cir- 
cumspect, he was always free from blustering and foolish mirth. A sarcastic 
smile mingled with an air of irony, sometimes sprung from his mouth and the 
six of the nose. He had a superb forehead, and a chin slightly prominent, full 



200 Bibliographical Notices. 

and firm, a clear skin and fresh complexion, thick lips, and passions more profound 
than violent. The expression of thoug-ht was always clear, precise, often pic- 
turesque, but sometimes scornful. His lectures ordinarily consisted of a simple 
exposition of facts, but in conversation and discussion, interrog-ation and irony 
were most conspicuous. The motions of his extremities and attitudes of his body 
were very negligent, but the tone of his voice, accent, movements of the head 
and physiognomy were very expressive. In fine, a certain fund of German good 
nature, redeemed some rather rude expressions of humour, which were neither 
sufficiently mild nor innocent not to produce a slight irritation. 

The cranium after death having been carefully separated with a saw from 
above the eyelids, was found of great thickness, (about three lines,) as well as 
hardness. Between the dura mater and pia mater there were about two ounces 
of a bloody matter, with some exuberances, one of which was about the size 
of a pea. The cerebral substance was firm and nearly in a natural condition, al- 
though during his illness it had been suspected that the brain was the organ 
chiefly affected. The skull cap and brain having been removed, weighed to- 
gether, four pounds, one drachm and a half; the skull cap itself weighed one 
pound, five ounces, one drachm. Thus the proper weight of the brain alone, 
when disengaged from its meninges, was two pounds, eleven ounces, and half 
a drachm, a weight indicating a brain, the dimensions of which are very near 
the maximum they ever attain. 

From all this our author remarks, "it is evident, that in the sense which he 
attached to the word philosophy, Gall had a head eminently philosophic. He 
v/as in fact skilful in distinguishing prejudices from eternal truths. He possess- 
ed an astonishing perspicacityforpenetrating into things, and exhibiting them in 
a point of view fruitful in useful resources. But in my opinion he wanted se- 
veral faculties to constitute a mind of the order of Descartes, of Newton, of 
Leibnitz, of Wolf, &c. perhaps even of Bacon. With him, in fact, the faculties 
of causality and comparison were well developed, but this was not sufficient to 
enable him to arrive at a system of philosophy at once severe and positive, 
which embraced at the same time every thing relative to man, and the chain of 
admirable phenomena which constituted the moral and physical order of the 
universe. Many organs, especially those of the mathematics, arts, localities, &c. 
were too weak in him to admit of his elevation to such a height. But he had 
the organization which qualified him to lay close hold on human nature and lay 
the foundation of the true philosophy of man. Many others, with fewer titles 
to our gratitude, have covered themselves with immortal glory." G. E. 



Art. XVni. System der Vergleichenden Anaiomie. Von J. F. Meckei, Professor 
der Medicine, Anatomic und Physiologic, zu Halle, Sec. &c. Erstcr Band 
Allgemeine Anatomic, Halle, 1821. Zweiter, dritter, und vierter Band, Be- 
sondern Anatomic, enhaltend die Skeletlehre, die Muskellehre und die Ver- 
dauungslehre Halle, 1824-25-28 und 29. 

Jl System of Comparative Anatomy. By J. F. Meckel, Professor of Anatomy, 
Medicine, and Physiology in the University of Halle, Sec. 

The French translation of the Comparative Anatomy of Professor Meckel, 
now in the course of publication at Paris, has been already announced to the 



Bibliographical Notices, 201 

Afnerican public through the pages of this Journal: the first, second, and third 
volumes, including the whole of the translation yet published, having been al- 
ready noticed in some of the preceding numbers. The German edition, it will 
be seen by a reference to the title affixed above, is considerably in advance of 
the French of MM. Reister and Sanson; the fifth volume having made its ap- 
pearance at Halle in the course of the last year. In making this annunciation, 
it is not our intention to examine the first three volumes, the contents of which 
have been already announced to our readers, but to notice the materials con- 
tained in the fourth and fifth. 

The fourth volume is taken up in the consideration of tiie muscular system, 
which is examined in the different classes of animals, commencing first with 
the echinoderma, and considering it successively in the annelides insects, arach- 
nides, Crustacea, moluscas, cephaiopodes, fish, amphibia, and mammalia. 

We regret that we cannot follow the author through the interesting details 
contained in this volume, every part of which bears the impress of that truly 
philosophic spirit which pervades all the literary labours of Professor Meckel. 
It is impossible to read this exposition of the muscular system, in the different 
classes and orders of animals, without finding ourselves carried away, in a spirit 
of admiration, at the wonderful adaptation of its several parts, to the wants and 
conditions of the several beings, which it is destined to subserve. 

In the fifth volume w^e have an elaborate examination of the digestive system 
extended through the several classes and orders of animals in nearly the order 
pointed out above. Here we have a most satisfactory exposition of the instru- 
ments of digestion in all their diversified forms and modifications, from their 
simple arrangement in the humblest zoopliyte, to the complex disposition which 
they present in the higher orders of the mammalia. In all we find an arrange- 
ment of parts adapted as well to the characters of the food upon which the ani- 
mal subsists, as the nature of its habitation, and external relations. In every 
part of this volume we find matter which, with the anatomist and physiologist, 
possesses the highest degree of interest, and is well calculated to establish the 
clearest conviction of the immense advantages to be derived from the study of 
comparative anatomy. We should be pleased to make copious extracts from 
the volume in question, convinced as we are of its great merit, but this pleasure 
we shall be obliged to forego, at least for the present, not without the hope, 
however, that it may yet be in our power, on some future occasion, to furnish 
our readers with a more satisfactory' account of the comparative anatomy of Pro- 
fessor Meckel. Our commendations are, fortunately, not necessary to ensure 
a due appreciation of its merits. If in France, where they have already the 
proud monuments, in comparative anatomy, built up by the geniuses of a Vicq 
d'Azyr, a Daubenton, a Cuvier, and a Blaiuville, this treatise should be consi- 
dered worthy of a translation, may we not hope that the English language, in 
which we possess no good treatise on tlie subject, may become enriched by a 
transformation of the work in question into an EngHsh dress? Such an event 
is highly desirable, and we should be much pleased to see some competent in- 
dividual occupied in so laudable an undertaking. 

The remaining volumes are to be completed at as early a period as possible; 
and if we may judge from the character of those already published, we have 

18* 



202 Bibliographical Notices. 

no hesitation in affirming-, that it will constitute, by far, the ablest treatise cm 
comparative anatomy contained in any language. E. G. 



XIX. Encydop'ddisches Wbrterluch der Medicinischen Wissenschaften. Heraus- 
geg-eben von den Professoren der Medicinischen Facultat zu Berlin: C. F. 
V. GaAEFE, C. W. HuFEiAND, H. F. Link, K. A. Eudolphi, E. v. Siebold. 
Zweiter Band. (Ahnung* Antimonium.) Berhn, 1828. 

The first volume of this medical Encyclopaedia has been already noticed in a 
preceding* number of this Journal, and as we propose to announce those wliich 
are to follow, to our readers, as soon as they are received, in accordance with 
this plan, we avail ourselves of the earliest opportunity of calling their atten- 
tion to the second volume, which made its appearance at Berlin, in 1828. It 
extends from the word Ahnung, (prae sag-ium, divinatio,) to Antimonium, and 
consequently embraces a wide range of interesting topics, which are for the 
most part treated with great ability. It must be manifest, that to comprise the 
leading principles which appertain to the several departments of medical sci- 
ence, within the small compass of twenty -five volumes, most of the articles must 
be short, otherwise numerous topics, all possessing more or less interest, would 
be entirely excluded. We accordingly find, that with but few exceptions, the 
articles contained in this volume possess considerable brevity. This is, indeed, 
carried in some cases to such an extent, as to amount to a fault. Upon a hasty 
examination, the articles which strike us as most elaborate are. Alter, (Aetas,) 
by Professor Rudolphi; Amenorrhoea, by Professor Berndt; Amaurosis, Profes- 
sor Benedict of Breslau; Amputatio, Dr. Grossheim of Berlin; Anastomosis and 
Anatomic, Professor Rudolphi; Aneurisma, Dr. Sommer of Frier; Angiectasie, 
Dr. Sommer; Angina, Dr. Sachse; and Anthropologic, Professor Rudolphi, &c. 
In designating these articles, it is far from our wish to detract from the others; 
we have selected them partly on account of their greater length, while we are 
conscious, that there are some of less extent, which possess even more merit, 
than some of those which have been designated. The article on angina is alto- 
gether too extensive, and has been made to encroach upon space which should 
have been allotted to more important matter: it occupies one hundred and 
thirty-five pages, almost one-fourth of the entire volume. We are disposed, 
however, to overlook these trifling faults, as the general literary execution of 
the volume is highly respectable. We hope, therefore, that the publication of 
the succeeding volumes may proceed without interruption; and we feel assur- 
ed, that when completed, the whole work will constitute a highly respectable 
monument of German medical literature. In the arduous, but praiseworthy en- 
terprize of editing and publishing medical encyclopaedias, the French were the 
iirst to lead the way; and so fully have they felt the benefit of such works, that 
in the space of a few years, no less than three works of the kind have been 
completed at Paris, and a fourth is at present in progress. The Germans have, 
with a commendable spirit, followed the example; and may we not hope, that 
the English and Americans will next be stimulated to collect and digest their 
medical literature in a similar manner? E. G. 



I 



Bibliographical Notices. 20^ 

XX. Ekmente der Mlgemeinen Anatomie in Verhindung mii der Allegemeinen 
Zergliederungskunsi. Von Dr. M. J. Weber, Professor und Prosector zu 
Bonn, Mehrerer Gelehrten Gesellschaften Mitgliede, &c. Mit Steintafeln, 
Bonn, 1826. 

Ekmente der Spedellen Matomie in Verhindung mit der Speciellen Zerglieder- 
ungskunsi. Von Dr. M. J. Webeb, &c. Zweiter theil Muskellehre, Bonn, 
1828. 

This is a treatise upon g-eneral and special anatomy, in connexion with a sys- 
tern of dissection, in which are contained rules for dissecting the different parts 
of the human body. 

Professor Weber divides dissection into general and special, according as it 
has for its object the investigation of the characters of the several tissues of the 
body, fHistography^J or the structure, form, relations, &c. of the different or- 
gans, (Morphography, or Topography,) of the human body. 

Some difference of opinion has existed relative to the time at which the ana- 
tomical student should commence his dissections, some advising that he should 
have previously attended one course of anatomical lectures, while others recom- 
mend that he should begin to dissect as early as possible. There can be no 
doubt that the student can profit more by dissection after he has heard a course 
of lectures, and has acquired, from the demonstrations of the professor, some 
knowledge of the parts which he has to expose, than if he were to commence 
without this preliminary information. Yet when we reflect upon the short space 
of time allotted to a course of medical studies, and that anatomical pursuits can only 
be attended to during the winter, we cannot help agreeing with the author, that 
dissections should be attended to from the commencement, and throughout 
the whole period of medical studies. We can speak upon the subject from con- 
siderable experience, and we are convinced, from the result of our own obser- 
vations, that the best plan the student can adopt, is, as soon as the professor 
has described any particular part, as for example, the muscles, the arteries, vis- 
cera, Stc.'to dissect them with attention, while the observations he has heard^ 
are still fresh in his mind. We, moreover, concur fully with the author, rela- 
tive to the impropriety of the student attempting to prepare all the parts in the 
course of a single winter. His time is so much occupied in attendance upon 
lectures and other duties, inseparable from his course of studies^ that it is im- 
possible for him to accomplish so much; and by attempting it, he only con- 
fuses his mind, and completely fails in acquiring that information which it is so 
necessary he should possess. A much better plan would be, for him to divide 
the objects of his research, so as to have a portion allotted for each winter ses- 
sion. If the arrangements of our schools were such as to require three years at- 
tendance on lectures, (which we regret is not the case,) we would recommend 
that during the first winter, the student should dissect the muscles, ligaments, 
■vessels, organs of digestion, respiration, urine, and generation; during the se- 
cond, the brain, nerves, and organs of sense; and during the third winter, he 
should attend to topographical or surgical anatomy, dissecting the several parts 
of which the different regions of the body are composed, in the order in which 
they present themselves, and observing, with attention, their mutual relations. 



!204 Bibliographical Notices. 

He should, moreover, daring the third winter, direct his attention to minute 
structure, or to the properties of the several tissues of which the entire organi- 
zation is composed. Professor Weber has advised that tliis latter subject should 
be attended to first, by the student, even before he proceeds to dissect the 
muscles, or any other part of the body, but we feel assured, that there are but 
a small number of students, who at so early a period of their studies, would be 
qualified to conduct such investigations. But while we recommend general ana- 
tomy, as an object of attention during the last session, we are not insensible of 
the immense advantage the student would derive, from an earlier acquaintance 
with tlie properties of the different tissues. 

The author goes on to speak of the advantages to be derived from dissection, 
and of the best means of realizing them; of the necessary instruments and appa- 
ratus to be possessed by the dissector, and finally, of the most successful means 
of preserving the health against the injurious consequences which arise from 
the influence of the unwholesome atmosphere of the dissecting room, and from 
wounds accidentally received in dissection. We cannot follow him through all 
these details, in which it will be sufficient to observe that his directions are ju- 
dicious. "We will merely subjoin, that amongst other means in common use to 
counteract the dangerous tendency of dissection wounds, he speaks of suction, 
first recommended by our respected collaborator. Dr. J. D. Godman, and sub- 
joins, *'that by comparing the result of the last sessions, during which this 
practice was adopted, with those obtained before, the good effects of suction 
were rendered very conspicuous." 

Dr. Weber next enters into some considerations relative to the classificatioH 
of the tissues, in which he objects to the arrangements made by Bichat, Wal- 
ther, Dupuytren, Meckel, Rudolphi, Mayer, and Heusinger, and proposes one 
which he thinks better. According to this arrangement, we have nine tissues, 
of which number, seven are simple, and two compound. The seven simple tis- 
sues are, the cellular, fibrous, cartilaginous, osseous, muscular, nervous, and 
horny: the two complex tissues, or rather systems, are, the vascular and glan- 
dular. Each of these are divided and subdivided in such a manner as to make 
them include all the different modifications of the organization, and without 
greater inconsistency than is usually met with in all similar attempts at classifi- 
cation. We do not think, however, that the serous tissues should be made to 
constitute a part of the cellular, as they are in Dr. Weber's arrangement. 

The author makes a brief, but satisfactory description of the properties of 
each of the tissues vvhich have been enumerated, and at the conclusion of each 
subjoins the best means of dissecting or examining them. These directions are 
calculated to be of considerable advantage to the student, but do not contain 
any thing new. 

The second volume of Professor Weber's work is devoted to the description 
of the muscles and ligaments. In looking over it, we find that the descriptions 
are generally well drawn up; and the directions which are given for the prepa- 
ration of the muscles are good, and cannot fail to afford great assistance to stu- 
dents, for whom they were intended. The third volume, or second part of the 
special anatomy, containing the angiology and splanchnology is announced by 
the author, as in press, and it is doubtless published before this time. We think 



Bibliographical Notices. 205 

the whole work, as far as we have yet seen it, is well suited to the dissecting; 
room, and that it cannot fail to prove a valuable acquisition to the student of 
anatomy. E. G. 



Art. XXI. OpuseuU di Chirurgia. Di Antonio Scakpa, Professore Emerito, e 
Direttore della Facolta Medica della I. R. Universita di Pavia, Cavaliere dell 
insigTie ordine Austriaco di Leopoldo, &c. &c. 2 vol. fol. Pavia, 1825. 

The work, the title of which we have here announced, is made up of me- 
moirs, composed by the author at different times, most of which have been al- 
ready before the pubUc. The object of the present publication is therefore to 
arrange and embody them, so as to render them more extensively useful, by 
facilitating- their circulation. The first volume, of 190 pages, folio, and six 
highly finished copperplates, treats upon the following subjects: — 1. A Memoir 
on Scirrhus and Cancer. 2. A Memoir on the Cutting Gorget of Hawkins^ 
3, A Note on Lithotomy. 4. A Memoir on the High Operation for Stone. 

5. A Letter to Professor Maunoir, on the Recto-Vesical Operation for Stone. 

6. A Collection of Cases relative to the same operation. 7. An Examination of 
the third Memoir of Professor Vacca, on the Recto-Vesical Operation. 8. A 
Note on the disadvantages of the same operation, when compared to the lateral 
operation. 9. A Memoir on Hydrocele of the Spermatic Cord. 10. A Memoir 
on Ascites taking place during Pregnancy. 11. Practical Observations on the 
advantages of the new method of practising the operation of paracentesis, in 
cases of Ascites succeeding Pregnancy. 12. Observations on the same opera- 
tion, compared to that used by Mr. Langstaff. In the second volume, of 200 
pages, and six elegant plates, engraved on copper by the celebrated Andulonij 
the following subjects are treated: 1. Perinaeal hernia. 2. The application of 
ligatures to the principal arteries. 3. Temporary ligature of the principal ar- 
teries. 4. The most speedy means of securing and obliterating the principal 
arteries. 5. The operation for aneurism, 6. Cataract and artificial pupil. 

7. Rare cases in surgery. 8. An extraordinary accumulation of milk in the 
mammae. 9. Extraneous bodies introduced within the rectum. 10. A varicose 
sanguineous tumour of the upper lip. 11. A varicose sanguineous tumour of 
the bony palate. 12. Aneurism of the arch of the aorta, with erosion of the 
first rib and the sternum. 

We have been thus particular in enumerating the contents of these volumes, 
as well on account of their great value, as from a desire to enable our readers 
to know where they can refer to the several memoirs and observations of the 
distinguished author, which have become exceedingly scarce in their detached 
forms. AVe would sincerely recommend every cultivator of surgical science to 
carefully study these memoirs. Like every thing which has come from the 
pen of the now venerable and renowned professor, they every where present 
the strongest evidences of great intellect, high attainments, extensive research, 
and excellent practical judgment and discrimination. There is especially one 
character presented by the memoirs in question, which we admire in all the 
author's compositions. Instead of being, like too many of our time, overanxi- 
ous to brandish forth every thing which may appear novel, as a new discovery,, 
he examines patiently in the first place what has been done by his predecessors, 



206 Bibliographical Notices. 

and cotemporaries, and by comparing their observations, with the result of his 
own experience, he arrives at such conclusions, as facts alone can warrant. 

He perceived and pointed out, at an early period, the numerous disadvantag-es 
attending the recto-vesicular operation for stone, so highly commended by M. 
Sanson, and Professor Vacca, and to the very able manner in which he has pour- 
trayed these disadvantages, in the volumes before us, and the bad success of the 
operation itself must be mainly attributed the disrepute into which it has already 
fallen, even though only a few years have elapsed since it was first recommend- 
ed. We had occasion, in 1825-26, to see the justice of some of Professor Scar- 
pa's objections fully verified. We had then an opportunity of seeing M. San- 
son perform the operation several times at Hotel Dieu, but although the stone 
was extracted with great ease, and without occasioning much constitutional 
suffering, either immediate or consecutive, and although Some of the patients 
were cured, without much difficulty, yet in several cases a permanent recto- 
vesical fistula was the consequence, which no treatment could heal. This is an 
objection which we think must always prevent the operation in question from 
being often performed, and will, doubtless, when taken in connexion with 
others alleged by our author, ensure its ultimate neglect. 

To enable our readers to form an estimate of the plates appended to these 
two volumes, it is only necessary to inform them that they are executed by An- 
duloni, who has already acquir(^ so much reputation by the highly finished and 
splendid engavings which accompany the other pubhcations of Professor Scarpa. 
Most of the subjects are represented of their natural dimensions, and with a 
degree of clearness and accuracy which we think no other engraver of anato- 
mical subjects has ever attained. We sincerely trust, that the author may be 
yet spared, although he has already reached a good old age, to publish new 
editions of his other works, many of which are exceedingly rare. E. G. 



XXII. JVosoIogie und Therapie der Chirurgischen Kranhheiten in Verbiridung mit 
der JBecshreibung der Chirurgischen Operationen; oder gesammie ausfuhrliche 
Chirurgie fur praktische Aerzte und Wundaerzte. Von C. J. Lakgenbeck, 
OrdeutHchen Prof, der Anatomic und Chirurgie, &c. &c. Erster Band mit 
drey Kupfertafeln Goet. I. 1822, pp. 704. zWeiter Band drey Kupfertafeln 
Gcet. 1823, pp. 984, dritter Band mit sieben Kup. Goet. 1825, pp. 920. 

When we reflect upon the numerous and rapid improvements which the 
Gennans are daily making in the difi^erent departments of medicine, it is to us 
matter of astonishment that so little should be known of their medical literature, 
on this side the water. Indeed, with the exception of the names of a few of 
their most distinguished authors, it may be justly affirmed that we scarcely 
know any thing of the medical character of our indefatigable brethren of the 
north, and yet it is an incontestible truth, that they have within a few years con- 
tributed more to the advancement of some of the departments of medical 
science, especially anatomy and physiology, than any other nation. Nor have 
they been behindhand in surgery. While England can boast of her Hunter, 
her BeUs, her Abernethy, and her Cooper, France of her Desault, her Du- 
puytren, her Boyer, Richerand, and Lisfranc, Germany has full reason to be 
jiroud of the names and reputation of a Graefe, a Rust, a Langenbeck^ a 



Bibliographical Notices. 207 

Klein, a Zang, a Seibold, and a host of others, whose labours have enriched the 
science, and estabhshed for German surgery an exalted and imperishable re- 
putation. 

We have been induced to make these remarks from the circumstance, that 
although the work of Professor Langenbeck, one of the most distinguished of 
modern surgeons, the title of which is placed at the head of this notice, has 
been before the public for some time, it is probably unknown in the United 
States. Convinced, as we are, of its high merits, we cannot avoid regretting 
that so little attention is paid to German medical literature, and that our numer- 
ous medical readers, who are unable to peruse works of merit in a foreign lan- 
guage, should not have these difficulties removed by the laudable enterprize 
of translators and publishers. Works, altogether worthy to be transferred into 
our language, are almost daily issuing from foreign presses, which, for want of 
the enterprize to which we have adverted, must remain, for the most part, un- 
known to the American public, except through the scanty gleanings wliich are 
contained in the journal. 

Only three volumes of the Surgical Nosology and Therapeutics of Professor 
Langenbeck have as yet reached us, though the whole work is to consist of 
nine, of which an entire volume is to be devoted to the diseases of the eye, an4 
another to those of the bones. Each volume is accompanied with copperplate 
engravings, representing the anatomy, diseases, instruments, operations, dres- 
sings, &c. In addition to these, may be advantageously taken in connexion with 
the work, the splendid anatomical engravings of the author, which embrace the 
entire anatomy of the human body. The configuration and structure of the 
brain are represented in forty copperplate engravings. The plates of the arte- 
ries and nerves are also done on copper, and are of a large size, one of them 
being four feet in length. 

The first volume of the work is taken up with the consideration of the cha- 
racters of inflammation, which are divided into general and special, implying by 
the latter, the numerous modifications presented by the process, as it attacks 
the different tissues. This division we consider highly advantageous, inasmuch 
as diseases are always modified by the character of the structures which they 
implicate, and correct views can only be formed by the application of general 
anatomy, to the elucidation of pathology. It is, in consequence of the adoption 
of this course of investigation, that pathological science has been brought to its 
present improved condition, an elevation which it owes to the discoveries made, 
and the impulse given, by the genius of Bichat. It therefore affords us much 
pleasure to see so distinguished an individual as Professor Langenbeck availing 
himself of the lights of general anatomy, to elucidate the principles of surgical 
pathology: a course which has been subsequently followed with great success 
by Roche and Sanson, Gendrin, and others. Such examples, v/e feel the. proud 
conviction, will always do more to maintain the high claims of general anatomy, 
and to establish a conviction of its important influence, than can ever be effect. 
ed towards destroying them, by volumes of such empty declamation, as that ut- 
tered by a late writer,* who has not only pronounced general anatomy to con- 
sist of unmeaning jargon, but has declared the most philosophic work on ana- 

f Dr. Knosu—Preface to his translation of Cbqnet's Anatomy, 



208 Bibliographical Notices. 

tomy,* that has appeared in this, or any other age, as little better than an as- 
semblage of nonsense and absurdities. 

The observations on inflammation in general, are drawn up with much abi- 
lity, and every where bear marks of the excellent critical acumen, with which 
the author has long since shown himself richly endowed. The general charac- 
ters are not only pourtrayed with masterly clearness, but the principal doctrines 
upon the subject are criticized with great candour and judgment. It is by 
studying the characters of healthy and diseased structure, by investigating their 
functions, as well in health as disease; or in other words, by making anatomy, 
physiology, and patholog-y, advance hand in hand, and mutually support each 
other, that our author has been led to establish such principles, as are proper to 
direct with a prospect of success, the ordinary therapeutic procedures. 

** When," observes he, *' my attachment to anatomical pursuits shall subside, 
my lectures, as well as my practice, will lose all their interest. This is, indeed, 
an event that can never take place; for when I look forward to a good old age, 
I feel the consolation, that when my eyes and hands render me an invalid in the 
practice of surgery, anatomy will furnish a substitute." 

Professor Langenbeck makes the following division of inflammation, which 
we give without comment: — 

1. Primitive, simple, or acute inflammation. — 2. Secondary, or symptomatic 
inflammation. — 3. Hypersthenic. — 4. Asthenic. — 5. Paralytic, or typhus.— 6. 
Specific. — 7. Chronic. — 8. Metastatic. — 9. Inflammatiom of the several tissues. 

These several varieties of the process are examined in succession, their nume- 
rous modifications are minutely detailed, and finally, the principles of practice 
are carefully laid down. In considering the characters of inflammation, as it 
aflfects the different tissues, our author commences with the skin, and passes 
the subject successively in review, as it implicates the mucous, serous, fibrous, 
lymphatic, nervous, arterial, and venous systems, and under each head, he not 
only points out the pathological characters of the disease, but also the rules 
of treatment. The first volume is concluded with some very sensible observa- 
tions relative to the subject of blood-letting, and the usual rules to be observed 
in practising it. 

In the second volume we have an exposition of the conditions usually express- 
ed under the appellation of termination of inflammation, as suppuration, ulcera- 
tion, and mortification. The termination by effusion is considered under the 
head of dropsy, and that by induration under the head of tumours, or new deve- 
lopments. 

Under the first head, or that of suppuration, the author very correctly ob- 
serves, that the suppurative process may be developed under three forms, viz. : 
1. In the substance of the tissues, giving rise to a cavity more or less extensive, 
filled with purulent matter, constituting what is called an abscess. 2. Upon the 
solution of a surface of continuity, which is, thereby, made to secrete pus, and 
to assume a condition which renders it impossible to heal it in any other man- 
ner than by the second intention. 3. From any of the natural surfaces, as 
mucous, serous. Sec. which instead of their natural secretions, are made to 
elaborate pus. The considerations which have reference to the second form of 

* Meckel. Manuel d'Anatomie. 



Bibliographical Notices. 209 

suppuration, are transferred to the third vohime under the head of wounds. 
The first form, or that of abscess, is ably examined, and the several varieties of 
the disease are carefully disting-uished from each other. They are, 1, the acute 
or phlegmonous abscess; 2, chronic; 3, topical or local, not depending* upon 
any constitutional cause; 4, constitutional; 5, metastatic; 6, superficial; 7, pro- 
found; 8, external; and 9, internal. Some of these distinctions we are disposed 
to consider superfluous, inasmuch as they do not express any fundamental dif- 
ference, but merely some accidental circumstances, of but trifling- consequence. 
The remaining" part of the volume is taken up in the consideration of the sub- 
jects of ulceration and gangrene, both of which are treated in an able manner. 

The third volume is devoted to the consideration of wounds, in connexion 
with which, are treated in a general manner, the subjects of hemorrhage, aneu- 
risms, &c. We regret that we are unable to enter upon an analysis of this part 
of the work. We have, however, no hesitation in affirming, that it contains a 
better digest of the doctrines and practice which appertain to those subjects, than 
any work we have seen. 

The plates which are annexed to the work are small, but are well calculated to 
convey a proper idea of the subject which they are intended to represent. We 
have, however, observed already, that the anatomical plates of the author, may 
be taken in connexion with the work in question, by doing which, the student 
would have an excellent system of surgical anatomy and surgery united. 

Having expressed ourselves in very favourable terms of Prof^essor Langen- 
beck's work, we cannot dismiss the subject, without expressing the hope that 
the remaining volumes may soon make theirappearance, and that the whole work 
may be completed in the highly creditable manner of the three first volumes. 

E. G. 



XXIII. Anatomie Pathologique du Corps Humain, ou Descriptions avec Figures 
Ltthographiees, des diverses Alterations Morbides dont le Corps Humain est sus- 
ceptible. Par J. Cruveilhier, Professeur d' Anatomic a la Faculte de Mc- 
decine de Paris, &c. &c. Fol. Paris, 1828. 

The first five livraisons of this work are contained in the fasciculus before us, 
which according to the prospectus is about one-eighth of the whole. The liv- 
raisons appear every six weeks, and cost nine francs each, about two dollars of 
our currency; consequently, when the work is complete, it will cost eighty 
dollars. Considering the beauty of the plates, and their whole number, (240 
when the work shall be finished,) the goodness of the paper, and the style of the 
press-work, this production of Mr. Cruveilhier is recommended by an extraor- 
dinary cheapness, such as would enable almost any medical man who is attach- 
ing himself to the study of pathological anatomy, to purchase it. 

Good plates in anatomy are of the greatest service to the student and practi- 
tioner at every stage of his connexion with medicine; where subjects however 
are in abundance, they may be dispensed with in the study of the normal con- 
dition of the human hody, but for pathological anatomy they are an absolute 
necessity. A description of a morbid alteration, however exact its language may 
be, generally fails to impress upon the reader the precise idea held by the wri- 
ter, and if there should have been no common preparatory standard in plates 

No. XL—May, 1830. 19 



210 Bibliographical Notices. 

or morbid dissections, the obscurity is still further increased. Moreover there 
are many morbid alterations of an uncommon kind, the traits of which, owing" 
to the imperfection of the human memory, would be lost even to the observers 
of them, without an accurate painting'; how much more difficult then would it 
be to communicate to others an idea of them by the mere abstractions of lan- 
g-uag-e. Mr. C. has stated with great justness in his introduction, that a faithful 
delineation of forms, colour, relative situation, dimensions, and details of tex- 
ture augmented by optical instruments, present a picture as eternal as nature, 
and protected from the vacillation of systems. It reproduces incessantly the ori- 
ginal image, recals to one person what he has already seen, and teaches an- 
other what he did not understand, dispenses with abstruse lectures, and leaves 
upon the mind deep and durable impressions. 

Tlie fasciculus of this work under our consideration, contains plates repre- 
senting some important diseases of the placenta and uterus, of the ganglionic 
nerves, of the kidneys, of the spleen, intestines, lungs, heart, testicle, in fine, 
of the several viscera contained in the abdomen, thorax, and cranium. 

At this early period, while seven-eighths are yet to appear, it would be ob- 
jectionable to enter further into an analysis of its merits and pretensions. It 
may therefore be sufficient to state, that from the opportunities known to be in 
reach of the author — from his preceding- contributions to the profession — and 
from the style of execution, and the subjects introduced into the five first liv- 
raisons, this work promises to be of the greatest utility, and comes recommend- 
ed to us in the strongest and most unequivocal manner. W. E. H» 



XXIV. Address to the Community on the Necessity of Legalizing the Study of Ana- 
tomy. By order of the Massachusetts Medical Society. Boston, 1829, pp. 27. 

AVe have read with much pleasure this document, and find in it the most sa- 
tisfactory reasons in support of the object stated. It has often been a matter of 
astonishment to us, that with the sound practical sense which is exhibited in 
the whole organization of society in New England, that with the eflTorts which 
are continually made there, to improve the moral and physical comforts of its 
inhabitants, laws of the most oppressive and unreasonable kind hang" like an 
incubus over the study of anatomy, and by their proscriptive violence, and fre- 
quent application, close this only avenue to sound medical knowledge. We 
trust, however, from the fairness and strength of the present appeal, and the 
bold and manly way in which it has been taken up in the report of a committee 
of the Massachusetts legislature, that a new order of things is about to com- 
mence, that vulgar and ignorant prejudices will yield to the cause of humanity 
and of science, and that by the freedom with which practical anatomy may 
hereafter be cultivated in New England, the vigorous and attractive state of 
her social institutions will be completed. 

We are the more pleased with this Address because it is a candid and open 
exposition of difficulties, and of the means of relieving them. It is a statement 
directly to the point, and must have weight if common sense and common phi- 
lanthropy are to be arbiters, and we trust that there is too much of both in the 
community to which the argument is addressed, for it to be controverted or 
passed over. 



Bibliographical Notices. 211 

The Address, after some general observations on the indispensable nature of 
anatomy to the accomplished physician, Avhich are sufficiently familiar to every 
medical man, g-oes on to quote several striking" instances of the loss of life from 
patients falUng- into incompetent hands. An aged practitioner reports more than 
a hundred persons, under his own observation, dying from strangulated hernia, 
and the question is very naturally asked, "how great must have been the num- 
ber in the whole of New England, who perished miserably from the same 
cause?" There are also several interesting cases given, somewhat at large, of 
death from the accidental wounding of large arteries by the ordinary imple- 
ments of husbandry, and other instruments. There is much good sense in 
making these statements, because positive instances of evil, are always more 
readily comprehended than mere abstract argument, and where a question of 
human misery is concerned, our sympathies are inevitably excited. It has been 
our misfortune to witness several of those horrors in the practice of surgery, 
arising from an ignorance of anatomy on the part of operators. If there were 
no other object in view than to stigmatise an individual, charity would induce 
us to suppress the narrative, but as an important argument is in question, it is 
proper to adduce it. During the brilliant campaign of our army, in 1814, on 
the Niagara frontier, many cases of severe wounds required surgical operations. 
A surgeon occupying a distinguished station through his commission, but cer- 
tainly not through any professional qualification, was a chief operator. We 
saw this person, in an amputation of the thigh, fail to cut through the great 
sciatic nerve; after the bone was sawed through, the limb still hung on by this 
nerve; ignorant of its nature, he made a plunge at it with his saw, the screams 
of the poor soldier attested the concentrated agony of a thousand operations, 
until the operator was implored by an assistant to desist and to use a knife. A 
captive officer of the enemy was wounded in the forearm, by a musket ball, 
and from the division of an artery, the bleeding was profuse; several days were 
spent in attempting to arrest it with a tourniquet. The pressure of the latter 
at length caused great tumefaction of the limb, and threatened mortification. 
The same operator instead of taking up the main artery above the wound, am- 
putated the limb, and the operation being performed while it was in a state of 
inflammation, the pain was immeasurably augmented, and the poor fellow finally 
fell a victim to the want of scientific skill. Such are the lamentable and shocking 
consequences of entrusting the lives of people to the uneducated in anatomy. 

The Address combats with success the arguments against carrying on dissec- 
tions in New England. One of them is of a very singular kind, for it proposes 
to the student to go elsewhere for his anatomy, to New York, Philadelphia, or 
Paris, no matter where. This is certainly very unjust and unreasonable; if dis- 
sections are in themselves improper, it amounts to a proposition to impose the 
evil upon other places, for the benefit of New England; a notion so selfish that 
we can scarcely believe it to be entertained by any conscientious individual, 
let his prejudices be what they may. The proposition also presumes upon 
what is contrary to the fact, that every student of medicine is in circumstances 
sufficiently easy to enable him to encounter the expense of a foreign edu- 
cation. 

The remedy for the want of subjects, proposed by the Address, appears to us 
both fair, humane, and sufficiently deferential to the existing prejudices of so- 



212 Bibliographical Notices. 

ciety. In every populous community, persons are found who have no ties of 
consang-uinity, relationship, or friendship, and it is generally admitted that the 
violence done by a dissection is not to the subject of it, but to living- individuals 
who are near connexions. But if the latter do not exist, the only consequence 
of a dissection is the exchanging" of the loathsome putrefaction of the grave, 
for the nice and attractive separation of the constituents of the body by an ana- 
tomist. We believe that there are few persons who upon seeing a dead body 
in a state of putrefaction woidd not think the latter by far the more horrible 
mode of man's returning to the elements which compose him, and would not 
compromise for something less humiliating and less disgusting. Burning, em- 
balming, in short any of the modes resorted to by nations, depending upon their 
peculiar customs, are, when philosophically considered, preferable to our go- 
ing through the same process of decomposition, which marks the end of the 
lower orders of animals, and yet the prejudices of education make us close our 
understandings to one of the most obvious laws of nature. 

To return, however, to the remedy. It proposes that the legal restrictions 
upon dissections shall not apply in the case of individuals who have no living 
relatives or friends to deplore their loss, and to bestow upon them the rights of 
sepulture, and who have been kept at the public expense. This proposition, 
though sound, is delicate — it draws an obnoxious line between the poor and the 
rich, and is therefore liable to popular objections. Here lies the difficulty, and 
to make acceptable so practical a distinction as this, in a country where all per- 
sons are theoretically equal, requires a casuistry of no small acuteness and abi- 
lity. It appears to us, that the best way of avoiding this dilemma, would be, to 
declare by a legislative enactment, what is admitted both by reason and reve- 
lation, that no dead body is intrinsically of any value, for the fiat is irrevocable, 
" dust thou art, and unto dust thou shalt return;" that relatives andfriends, how- 
ever, possess a right to the remains of their dead, which right they may exer- 
cise in any way they think proper, and be secured in; but that in the case of 
individuals not connected with the living by cherished associations, their bodies 
are to be estimated only by the rule of positive value, and that if a grievance 
can be proved to have been suffered by any one through their dissection, the 
party may obtain equivalent damages, by law or otherwise. 

A regulation of this kind would be just and would provide sufficiently for the 
case in point; but an abstract and sweeping legislation on dead bodies appears 
to us absurd, because it makes of consequence a mass of matter which the laws 
of nature sufficientl)'^ prove must return rapidly, sometimes in a fortnight or 
less, to the elements which compose it. If a wrong, then, be suffered by a dis- 
section, this wrong is inflicted upon the feelings only of the living who were 
nearly allied to the dead, but where from the want of relatives and friends it is 
not possible for such feelings to exist, it is obviously absurd to make in point of 
law the latter case a parallel with the former. Our meaning is that the sanctity 
of the tomb should be protected by sufficient laws, but that in the case of a pro- 
secution for violating it, it should be made to appear that there is an aggrieved 
party, and a more substantial plaintiff than the general and indefinite preju- 
dices of society. The real esteem felt for the dead would then show itself by 
the persons actually interested, coming forward to spend their time and money 
in the prosecution. 



Bibliographical Notices. 213 

If thing's were put upon such a footing, society would soon adjust itself upon 
this point of rig-ht, as it does upon all others— and that knowledge of anatomy 
for which they look in their physicians, and which is indispensable to their com- 
fort, would be always attainable. We have no doubt that a community is fre- 
quently made by the laws, as they exist, to perform a part in a prosecution for 
dissection, which part is diametrically opposed to the sentiments of a large ma- 
jority. It is quite time that an art so important as anatomy to the interests of 
humanity should be properly represented, and have fair play, in a court of jus- 
tice,- and that the laws of society should not present the monstrous inconsis- 
tency of making a surgeon punishable for the mal-treatment of a patient, and 
also punishable for resorting to the only means by which he can get information 
on surgical cases. 

It is an egregious mistake to suppose that in a question of dissection, the in- 
terests of society are upon one side, and those of physicians on the other — for 
as dissections are actually only practised for the public good, the proper array 
of parties is to put upon one side the relatives and nearest friends of the de- 
ceased, and on the other, the community with its medical corps. The issue of 
a fair trial would then show the amount of damage sustained, and a suitable ver- 
dict would be rendered. We have but little doubt that the ])rogress of the hu- 
man mind, and the application of the principles of our benign religion, will ul- 
timatel}' put dissections upon this footing, and we should rejoice to see Massa- 
chusetts, the cradle of our political independence, also the cradle of our men- 
tal regeneration in this respect. W. E. H. 



XXV. The Anatomy, Physiology y and Diseases of the Teeth. By Thomas Bell, 
F. R. S., F. L. S., F. S. S., Member of the Royal College of Surgeons in Lon- 
don, &C.5 Lecturer on the Anatomy and Diseases of the Teeth at Guy's Hos- 
pital, and Surgeon-Dentist to that Institution. Carey & Lea, 1830. 8vo. pp. 
351, plates XI. 

On a former occasion we noticed some of the principal works on dentistry, 
and pointed out how much a complete treatise on this department, au cmirant 
with the present improved state of physiological, pathological, and therapeuti- 
cal knowledge was wanted. This desideratum is indeed universally felt and ac- 
knowledged, and to furnish it — to correct the errors, and supply the deficien- 
cies of other writers — to place in the hands of the student and of the medical 
practitioner, a plain and practical digest of the information at present possessed 
in the art — and to lay before them the result of the author's own investigations 
and experience, is the object of the author of the treatise, the title of which is 
at the head of this notice. In the accomplishment of his design, Mr. Bell has 
succeeded to a very creditable extent, his work being decidedly the best that 
has appeared, at least in our language. The author is not a mere compiler, but 
as we are informed, has been long distinguished as an able practical dentist and 
scientific lecturer on dental surgery, at one of the principal hospitals in Lon- 
don. His treatise is divided into two parts — the first is devoted to the anato- 
my and phy.siology of the teeth — the second to their diseases and treatment. 
The very nature of the work, renders it impossible to present an analysis of it 
within the limits of a notice like the present. We must therefore confine our- 

19* 



214 Bibliographical Notices > 

selves to merely expressing" in general terms our favourable opinion of the 
work, and acknowledging the pleasure and instruction that we have derived 
from its perusal. 



XXVI. Atlas Historique et Bihliographique de la Mddecine compost de Tableaux 
sur I'Histoire de I' Anatomic, de V Physiologic, de I' Hygiene, de la Medecine, de la 
Chirurgie et de P Obstetrique, &c. Par Casimir Broussais, Docteur en Mede- 
cine, Chirurg-ien Aide-Major du Gymnase Normal Militaire et Civile, Profes- 
seur Agrege a la Faculte de Medecine de Paris, &c. &c. Paris, 1829. Folio, 
pp. 44, 

This work consists of seven tables, the first devoted to the history of anatomy, 
the second to that of physiology, the third to hygiene, the fourth to medicine, 
the fifth to surgery, the sixth to obstetrics, and the seventh to a chronological coup 
d'oeil of all the epochs. The tables are arranged on the same plan as those in 
Lavoisne's Atlas, and exhibit at a single view the history of the science — its prin- 
cipal epochs — its progress in different countries — and the names of those wh® 
have cultivated it with most success, the period at which they flourished, the 
country in which they lived, and their principal discoveries or works. Joined to 
each of these tables, is a list, arranged alphabetically, of the authors of the princi- 
pal works in the department to which the table is appropriated, with the title of 
their first work, and the period of its publication. Following these tables, there 
is a list of the principal universities and schools of medicine, with the date of 
their foundation — a catalogue of the editions of Hippocrates, Celsus, Erotien, 
Galen, Oribasis, and Avicenna, with the names of their translators — a list of the 
principal medical journals — and a catalogue of the chief works on the history of 
medicine. 

Our Umits will not permit us at present to discuss the value of a knowledge 
of the history of our science, or to point out the merits and faults of the work 
of M. Broussais. The former we regret the less, since it can hardly be sus- 
pected that any one of intelhgence can doubt its importance; and as to the 
latter, we should have so much more to commend than to censure, that we are 
satisfied to pass over the faults, and recommend the work to the attention of 
the student. We must, however, remark that the American physician, in ex- 
amining this work, will be disappointed in not finding any notice of many of 
those who have contributed most to the progress of medicine in this country, 
while he will learn for the first time, of the celebrity, probably the very names, 
of some of those quoted by M. Broussais. 



i 



( 215 ) 



QUARTERLY PERISCOPE, 



FOREIGN INTELLIGENCE. 



ANATOMY. 

1. Congenital Absence of the Iris without loss of Vision. — The cong-enital 
absence of the iris, without loss of the sense of sight, is one of the most 
uncommon and singular organic anomalies. M. Rudolphi, (Grundriss der 
Physiologie, t. ii. part i. p. 221,) has doubted whether it has ever been ob- 
served? but we are now in possession of many facts which leave no room for 
incredulity. The change from the natural state to the total absence of the 
iris appears to be formed by congenital irregularities in the figure of the pupil. 
The first degree of anomaly is constituted by the oblong and perpendicular 
pupil, like that of the cat. Another preternatural formation consists in the 
division of the iris from the inferior margin of the pupil to the union of the 
cornea with the sclerotic coat. 

Dr. Behr briefly reports all the known cases of total absence of the iris. 
Klinkosch, (Programma quo sect, et demonsta. indicit. Prague, 1766; Meckel, 
Pathol. Anat. t. i. p. 395,) first observed this anomaly, but in a case where 
there also existed organic malformation of the eye and the whole body. The 
first case of complete congenital absence of the iris, without any other com- 
plication, was communicated to the Societe du Cercle Medical de Paris, by 
Mr. A. Morisson, of London, (Nouveau Journ. de Med. &.c. t. vi. p. 105;) M. 
Baralta lias described two eyes, in each of which the iris was wanting, 
(Praktische Beobacht. Uber die vorziiglichsten Augenkrankheiten.) Professor 
Dzondi mentions a similar case, (Rust, Mag. f. d. ges. Heilkunde, t. vi. p. 33; 
and another is reported by Dr. Psenitz, of Dresden, (Zeitschrift fUr Nat. und 
Heilk. t. ii. p. 214.) Last?ly, M. Behr gives us the details of the following 
case, which he himself saw. 

Caroline Schwabe, born in 1826, from the first day of her life, was so sensi- 
ble to the impression of light, that she cried loudly whenever any luminous 
rays fell upon her eye. Her mother could perceive nothing peculiar in her 
eyes; but M. Behr, upon examining them in May 1827, discovered a total ab- 
sence of the irides. The eyes of the mother and father were blue, and 
naturally formed. The child presented no other irregular formation, except- 
ing that the upper eyelids were thick and swollen, and the eyebrows covered 
with light weak hair. By degrees the infant became accustomed to light, but 
the eyes were always very mobile, and agitated in their orbits. The cornea 
was rather more convex than usual. In November 1827, she was attacked 
with measles, accompanied by excessive sensibility of the eyes. September 
1828, the child could direct the eyes steadfastly to any object, and the sclerotic 
was now seen of a bluish tint, and the large pupil of a deep black colour. 
"When the child was placed at the extremity of a room, and rays of light were 
directed through the window upon the eyes, a phosphorescent redness was 
perceived, which gave to the eye the aspect of a luminous ruby, or of a burn- 



216 QUARTERLY PERISCOPE. 

ing- coal. The visual faculty did not appear to be affected by this anomalous 
structure of the eyes. The child, however, seemed to be more comfortable 
in the weak light of the evening-: she was then more cheerful and playful than 
at other times. She could see also in almost total darkness. The brightest 
colours, as red or yellow, were the most agreeable to her. If she wished to 
examine any minute object, she drew it very near her, and always placed it 
below the visual axis. It appeared painful to her to look upwards, even in a 
weak light. The other senses were perfect, and her hearing was remarkably 
acute. — Lond. Med. andPhys. Journ. Jan. 1^30, from, Hecker'sAnn. Aprils 1829. 

2. Communication of the lymphatic Vessels with the Veins. — M, De Blainvillb 
read to the Academy of Medicine at their sitting on the 3d of August last, a 
letter from Dr. Dubled, agrege of the faculty of Paris, in which this physician 
announces that he has injected the two inferior thirds of the thoracic duct, and 
some of the neighbouring lymphatic vessels, by forcing an injection by the in- 
ferior vena cava. He has observed that in order that this passage may take 
place it is necessary that the last mentioned vein should be forcibly distended, 
and to verify this fact he has made the following experiment: — The inferior 
vena cava having been tied below the diaphragm, in a living animal, he found 
many hours afterwards, blood in the thoracic duct, and in some other vessels 
of the same system. — Archives Generates, Nov. 1829. 



PHYSIOLOGY. 

3. Partial Loss of Memory. — The late Dr. Schoerf, the author of several va- 
luable medical works, on his recovery from a violent attack of fever, did not 
recollect a single word of Latin, though his memory in every other respect 
seemed perfect. He was very uneasy, not knowing how he should be able to 
write his prescriptions? but after a few days of convalescence, Latin words re- 
turned insensibly to his memory as his strength increased, and finally he be- 
came as good a Latinist as ever. — Hif eland's Journal, Dec. 1828. 

4. On the Regeneration of Bone. — M. Flourens read a communication to the 
Royal Academy of Sciences, at their meeting on the 20th July last, on the rege- 
neration of bone. M. F. has made a number of experiments on young birds, princi- 
pally pullets, and the following are the results at which he has arrived. 1st. If the 
external periosteum of a bone of the cranium be removed, the external lamina 
of this bone becomes necrosed, and is thrown off; in this case a new periosteum 
is first formed, afterwards a cartilage, which subsequently ossifies. 2d. If a bone 
of the cranium and its periosteum is removed entire, the dura mater remaining 
perfect, this latter membrane reproduces only the internal lamina of the bone; 
the external is reproduced, as in the preceding case, by a periosteum newly 
formed. 3d. If the periosteum, the bone, and dura mater are removed, a new 
periosteum and a new dura mater are first formed, afterwards a double cartilage is 
produced between these two membranes, which is finally converted into two os- 
seous lamina. 4th. All bones are not susceptible of reproduction; those which 
the author has seen reproduced in his experiments are, the frontal, the occipi- 
tal, the parietal, and the other bones of the vault of the cranium; but the os- 
seous envelope of the semicircular canals, and these last themselves are not re- 
produced. Nevertheless if a canal has been only divided, the two ends reunite 
after a time and are connected by a bone which at that point obliterates the 
cavity of the canal. M. F. gives the foUoMdng account of the mechanism of this 
reproduction. 1st. It is always the periosteum or the dura mater which is 
first reproduced, and they afterwards reproduce the cartilage and the bone. 2d. 
It is always the old periosteum and the old dura mater, which give birth to the 
new periosteum and new dura mater; it is also at the borders that the new or- 



Pathology. 217 

ganization always commences. 3d. The new bone is never as regular in its 
structure as the primitive one; the two lamina of which it is composed are often 
confounded together, or at least are only separated by an imperfect diploe. 4th. 
An effusion of organizable lymph, at the border of the part which forms it, al- 
ways precedes a new progress of formation. — Archives Generales, Oct. 1829. 

5. Instance in which Life tvas supported for a length of time hy the Msorption 
of the Fluids of the Body. — A very curious instance of life being supported by 
the absorption of the fluids of the body, is related by Mr. Granger, in his Ele- 
ments of General Anatomy, as having occurred some years since at Dover. "A 
hog weighing one hundred and sixty pounds, was buried under a portion of the 
cliff, which fell on its stye, for the long space of one hundred and sixty days. 
At the end of this time, being dug out, it weighed only forty pounds, and was 
extremely emaciated, clean, and white. As there was neither food nor water in 
the stj'^e, when the cliff fell, this hog must have existed during the time men- 
tioned, by the removal of the adipose and other fluids from their containing 
structures into the circulating system," 

6. Reciprocal Action of Gases through Animal Membrane. — It would appear 
from the following singular observation, made by Thomas Graham, Esq. Lec- 
turer on Chemistry, at Glasgow, in the course of an investigation respecting the 
passage of mixed gases through capillary openings, that endosmose acts upon 
aeriform matter, as it does upon bodies in the liquid state. We feel every day 
more and more convinced that this property acts a most extensive and impor- 
tant part in the functions of the animal economy. 

" A sound bladder with a stopcock was filled about two-thirds with coal gas, 
and the stopcock shut; the bladder was passed up in this flaccid state, into a 
bell-jar receiver filled with carbonic acid gas, and standing over water. The 
bladder was thus introduced into an atmosphere of carbonic acid gas. In the 
course of twelve hours, instead of being in the flaccid state in which it was left, 
the bladder was found distended to the utmost, and on the very point of burst- 
ing, while most of the carbonic acid gas in the receiver had disappeared. The 
bladder actually burst in the neck, in withdrawing it from under the receiver. 
It was found to contain 35 parts of carbonic acid gas by volume in 100. The 
substance of the bladder was quite fresh to the smell, and appeared to have un- 
dergone no change. The carbonic acid gas, remaining without in the bell-jar, 
had acquired a very little coal gas. 

*' The conclusion is unavoidable, that the close bladder was inflated by the in- 
sinuation of carbonic acid gas from without. 

"In a second experiment, a bladder containing rather less coal gas, and si- 
milarly placed in an atmosphere of carbonic acid gas, being fully inflated in fif- 
teen liours, was found to have acquired 40 parts in 100 of this' latter gas. A 
small portion of the coal gas left the bladder as before. 

"A close bladder, half filled with common air, was fully inflated in like 
manner, in the course of twenty-four hours. The entrance of carbonic acid gas 
into the bladder depends, therefore, upon no peculiar property of coal gas. 
The Madder, partially filled with coal gas, did not expand at all in the same 
bell-jar, containing common air or water merely." — Quarterly Journal of Sci- 
ence, October, 1829. 



PATHOLOGY 



7. Wandering Paralysis with loss of Memory. By Dr. DuauEs?fELL. — A ma- 
son, aged about twenty-five, married eight da3'^s, of rather a robust constitu- 
tion and sanguineous temperament, had had in 1823 pneumonia, during 
which symptoms of hypertrophy of the heart appeared, which since made but 



2 IS QUARTERLY PERISCOPE. 

little progress. At different periods he had been attacked with pulmonary ca- 
tarrh and slight gastritis, attended with violent pain in the epigastrium. June 
29th, 1829, the temperature of the weather being moderate, he returned from 
Senlis to Royaumont. The next day he complained only of a slight cough, 
(he had had for several days a slight catarrh.) About two o'clock in the after- 
noon, he experienced suddenly, whilst eating, a very acute pain in the left mas- 
seter muscle and articulation of the jaw of the same side, and felt a kind of 
crepitation in these parts. This pain in a short time extended itself over the 
whole corresponding side of the head and neck. Afterwards giddiness, dim- 
ness, tennitus aurium and difficulty of pronunciation supervened. He went to 
bed, where Dr. D. saw him at 5 o'clock, at which period he was in the follow- 
ing state: face red, much injected; eyes brilUant, pupils moveable, look asto- 
nished; mouth and tongue natural; pulse slow and full, intermitting every third 
or fourth pulsation; acute pain over the whole of the left side of the head and 
neck, augmented by the touch, especially on the region of the masseter mus- 
cle, which was slightly swelled. Incomplete paralysis of the whole right side, 
the limbs of which side were incapable of voluntary motion; when pinched 
strongly, sensation was experienced, and a slight movement was perceived. 
After having well verified all these symptoms, Dr. D. retired to another room, 
and to his great surprise saw in a few minutes the patient enter after him, walk- 
ing alone and without any aid, the right arm hanging, and without dragging the 
right leg. He laid down on a bed that was in this room, and there Dr. D. ex- 
amined him anew; he presented the same symptoms as before, only the right 
lower extremity had recovered a little its power of motion; however the patient 
experienced a great difficulty of speaking, and could not answer the questions 
asked him, though he understood them veiy well, except by the monosyllables 
oui, non, bon, bien, ne, pas, and by the v/ords, je ri^peux, je rCptux bien, je ne, 
which he often repeated involuntarily, and very absurdly, though he knew 
what he ought to answer. Some hours afterwards the limbs recoveredthe pow- 
er of motion, and his speech improved. Leeches were applied behind the ears, 
cold applications to the head, sinapisms to the legs, enemata of sulphate of 
soda, and emollient cataplasm to the cheek. 

July 1st. — The patient had slept well; the leech bites had. bled freely, alvine 
evacuations abundant. Face less red, eyes less haggard, tendency to drowsi- 
ness, tennitus aurium, diminution of pain, no trace of paralysis, pronunciation 
better, but he could articulate only the words already mentioned. Same reme- 
dies were ordered to be repeated. 

July 2d. — The patient was up and walking, as if in perfect health; but the 
difficulty of speech and the forgetfulness of words had not much diminished. 
With a book in his hand, he read aloud fluently and without stuttering, but he 
could not with all his efforts repeat more than two or three words of a sentence, 
even a very short one, which he heard. After a short time, he was able to 
perform addition upon paper, but could not by memory. Though he had been 
accustomed to sing every night, he could not recall a single word of his most fa- 
miliar songs. The condition disappeared gradually, and by the commencement of 
August, there only remained a slight defect of memory. — Archives G^n^rales^ 
November, 1829. 

8. Loss of Sensation in one-half of the Body without Loss of the Power of 
Motion. — Notwithstanding the numerous researches of modern physiologists, 
and the ingenious experiments they have instituted to elucidate the mechanism 
of the functions of the nervous system, we are still ignorant what portions of 
the brain are the exclusive seat of sensibility, and what determine the move- 
ments, though observations similar to the one we are about to notice, show that 
these faculties are entirely isolated. The following interesting case, related 
by Dr. Li; Sauvage, of Caen, in the Archives G^nerales, for November last, 
affords a very remarkable example of the possibility of the loss of sensation 
without the locomotive faculties suffering in the shghtest degree. A man 



Pathology. 219 

ag-ed seventy-three, well made, habitually enjoying good health, had perceived 
for fifteen days some giddiness, when on the 10th of March, 1828, being about 
fifty steps from his house, he experienced suddenly a numbness in the whole of 
the left lower extremity. It appeared to him that his foot sunk deeply, and he 
seized his thigh with both hands, as if to prevent its sinking into the ground. 
Almost at the same instant, the numbness extended over the whole left side. 
Alarmed at this unusual condition, he became anxious to get home, and ran 
with facility that distance. The next day Dr. Le Sauvage was sent for, who 
found the patient in the following condition; the intellectual faculties natural; 
the pulse nearly the same in both sides of the body; he could walk, move his 
arms, and take hold of objects without difficulty, only the elevation to which 
the arm could be raised by the deltoid was a little limited; but he had no con- 
sciousness of the movements he performed, nor of the bodies he touched. The 
skin over the whole left side was absolutely insensible; he might be pinched 
and pricked on this side ever so much, without his perceiving any pain, or even 
without his being aware of it. At the anterior part of the body, the median 
line was not the precise limit of the sensible parts. On the left side, the skin 
possessed sensation to the extent of about an inch from this line: beyond this 
point there was complete insensibility on this side. On the affected side, the 
sight and hearing were perfectly natural, but the senses of smell and taste were 
lost. When the left half of the tongue was wet with strong vinegar, the patient 
did not taste it in the least, whilst the taste of this fluid was strongly perceived 
by the other half of this organ. Strong odours placed under the left nostril 
were not perceived, except when the patient made a strong inspiration, but 
then the odour passed to the right nostril through the posterior nares. When 
the hand was placed upon the head, the patient felt only that portion resting 
on the right half, &c. This affection has hitherto resisted all treatment. The 
constitution of the patient, however, does not appear to have suffered any 
injury, 

9. Case in which Blood was found in the Lymphatics. — A man, aged thirty- 
six, of middle size, and rather robust, experienced for some days general in- 
disposition with considerable prostration of strength, without any apparent 
cause. He next perceived that the upper part of the neck on the right side, 
became swollen and covered with phlyctinse, over a space equal in size to that 
of a five-franc piece. In the centre of this spot the epidermis was raised, and 
discovered the dermis, which was of a brown colour. At the same time the 
lips swelled, and became covered with minute miliary vesicles. There was 
anorexia, fever, and oppression: the patient seemed to have the commence- 
ment of a severe attack of erysipelas, or even of mahgnant pustule. However, 
the general symptoms as yet indicated nothing alarming. The patient was or- 
dered to be watched, while simple beverages and attention to diet were enjoin- 
ed. He died the same evening, without having presented any other symptom. 
Examination.— The cellular tissue beneath the exanthematous patch on the 
neck was ecchymosed, but no other change was perceptible at this part. The 
stomach had elevated patches scattered over it, similar to those which are met 
with about the ileo-coecal valve. The rest of the alimentary canal was free 
from disease. The body was sent to La Pitie for dissection, where some pupils 
having removed the abdominal viscera, were proceeding to study the muscles 
of the loins and pelvis. In raising the peritoneum which covered the lower 
part of the spine, they found on the last lumbar vertebra, and in the hollow of 
the sacrum, a set of vessels highly injected, and of a deep red colour. Their 
disposition, numerous anastomoses, and connexion with the lymphatic ganglia, 
left no doubt of their nature, and it was perceived that all this system of vessels 
was filled with blood. Whence came this liquid, or how had it found its way 
into an order of vessels which does not naturally admit it? None of the neigh- 
bouring organs had been the seat of haemorrhage; neither veins nor arteries were 
altered, in a word, there was nothing to explaiv the phenomenon. These 



220 QUARTERLY PERISCOPE. 

lymphatics were traced upwards with great facility, into the thoracic duct, 
which was injected in the same manner, even till its junction with the subcla- 
vian vein, which was in its natural state. The liquid from the lymphatics was 
analysed by M. Barruel, and ascertained to be really blood; and a drawing- was 
made from the preparation by Dr. Carswell, so as to preserve the appearances. 
Changes in the lymphatic system become less rare, in proportion as investi- 
gations relating to it multiply. Besides the facts recorded by M. Andral, others 
have been collected in England and Germany, which prove that the thoracic 
duct is susceptible of alterations no less severe than numerous; it has been 
found filled with pus, with softened medullary degeneration, &c. obliterations 
of the duct have been noticed; partial dilatations and strictures, or narrowings, 
of a greater or less extent; its parietes have been found ulcerated, thickened, 
and altered in various other ways. But the particular pathological fact which 
we have above related, is regarded by MM. Dupuytren, Breschet, and Sanson, 
as unique. — Lancetie Frangaise. 

10. Case of Disease of the Lymphatic System. — This interesting case was com- 
municated to the Royal Academy of Medicine by M. Amussat. A lad aged 19, 
had a swelling in each inguinal region, which had been treated during five 
years by compression. Although the application of the truss always caused con- 
siderable pain, it immediately subsided after its being taken off; whenever he 
attempted, however, to walk without the bandage, the pain in the tumours be- 
came almost intolerable. On his arrival, and during the first days of his stay at 
Paris, he felt pretty well. On the morning of the 7th of November, however, 
he awoke with violent pain under the right breast and in the groin, and great 
difl[iculty of breathing; the tumours were very tender, and the skin over that of 
the left side slightly inflamed. There were no local or general symptoms of 
incarcerated hernia. Venesection from the arm, leeches and fomentations to 
the tumours, and a warm bath, were without any eifect; the abdomen becam.e 
tympanitic, &c. and the patient died on the 9th of November. 

On examination of the body twenty -four hours after death, the tumours were 
found to be deposits of purulent matter, contained in very thin cysts, the tex- 
ture of which somewhat resembled that of the serous membranes; they commu- 
nicated with the abdomen by means of the crural arch, and descended to a con- 
siderable extent between the fascia lata and the muscles of the thigh. The 
peritoneum contained a great quantity of purulent matter, which at first sight 
was supposed to be the result of psoitis. On careful examination of the tho- 
racic duct, however, it appeared that this canal, as well as the whole of the 
lymphatic vessels of the abdominal cavity, was filled with real pus. M. Amussat 
tied some of the lymphatic branches, which were considerably enlarged, and 
showed to the entire satisfaction of the practitioners present, that these vessels 
communicated with the accumulation of purulent matter, and that the canals 
filled with pus, which they had considered as being the result of feculent infil- 
tration in the cellular tissue, were actually enlarged lymphatic vessels. The tu- 
mours in the inguinal regions were found to be lymphatic vessels enormously 
dilated, so as to resemble hernial sacs. — Gazette de Sante. 

11. Case of Idiotism and Aphonia, produced hy Fright^ in a Woman at the Se- 
venth Month of Pregnancy. — This interesting case is related by Madame Boivisr, 
in the Journal Complementaire du Dictionnaire des Sciences Medicates, A female, 
aged twenty-three, nervous constitution, bilious temperasment, dark brunette, 
a mother at the age of twenty, her labour taking place at the seventh month of 
pregnancy, in consequence of bad treatment from her parents. The accouche- 
ment was preceded and followed by an abundant metrorrhagia and frequent 
faintings. Her health was however restored, and she left her paternal mansion 
and went to Paris. She again became pregnant, and at the sixth month of utero- 
gestation she became extremely jealous, violently reproached and menaced her 
lover, who after vain attempts to calm her, threatened to have her removed 



Pathology, 221 

from his dwelling- by force, and went out to seek a pollc^officer. The patient 
immediately hid herself, and it was not until after a long- search that she was af- 
terwards found in a closet of a wardrobe. She was found in a state of stupor, 
which was at first supposed to be feigned. But nothing" that could be said could 
induce her to leave her retreat or change her attitude or expression. It was ne- 
cessary to remove her, and a physician was called, who thought that the patient 
was feig-ning". She however did not speak, nor make any signs; she did not 
exhibit any wants, and preserved any position in which she was placed. In this 
state she was taken to La Maison Royale de Sante, August 20th, 1820, two 
days after the occurrence, and was placed under the care of M. Dumeril. She 
was here carefully watched by a special attendant. Her aspect at this period 
was frig-htful — her black hair stood erect on her head — her dark face, thin and 
excessively pale — her large black eyes, surmounted by thick eyebrows of the 
same colour, were fixed and prominent — her mouth wide open, and her chin 
resting" on her chest. When any one entered her chamber, she turned her 
head, looked aside with an expression of fear, afterwards examined the person 
attentively as long as they continued in the room. She did not speak nor move; 
it appeared as if she did not understand any thing that was said to her. Her 
appearance was so hideous that she was called by the other patients the vam- 
pire. 

This singular state was unaccompanied with fever. An infusion of orange 
leaves, and a draught with ether, were ordered; but twenty-four hours elapsed 
without its being possible to induce her to take a cup of this liquid: she had not 
taken any thing during the preceding two days. In the course of the fourth day, 
the sixth from the attack, she refused as usual the drinks which were offered 
her; but she made signs that she v/anted an empty bottle that was in her sight, 
which was given her, when she put into it some of the fluid, and drank for the 
first time during six days. She had only urinated once, and then in her bed, and 
had not slept during this period. She continued afterwards to take drinks, but 
only with the bottle. A duoche ascendante produced an evacuation from her 
bowels for the first time in six days. 

The fifth day she took a little soup, and she was taken into the garden. She 
sat upon the ground, collected together the sand, selected the pebbles and 
shells that she found in it, and amused herself as if she were an infant of two 
years of age. Some one pretended to wish to take them away from her; her 
face immediately took on an expression of great anger, and afterwards she 
wept heartily. When the pebbles were returned to her, she exhibited a stupid 
joy. She continued this puerile amusement during twelve days; her speech did 
not return, and she did not give any sign of a return to reason. 

The sixth day a large blister was applied to her neck, but neither during the 
drawing or dressing did she exliibit any signs of pain. 

On the eighth the shower bath was ordered. The patient on being stripped 
entirely of her clothes, made no resistance. When the water fell upon her she 
appeared seized with fright; her limbs Were violently agitated; but she did not 
attempt either to rise or remove herself; she neither groaned or cried; her re- 
spiration became suspended; finally, syncope came on, from which she was 
with difficulty revived. After being placed in bed she slept many hours. She 
showed afterwards by signs that she remembered the shower bath. 

On the twelfth day she showed by signs that she had pains in her right leg. 
A flying blister was applied to her knee and the pain disappeared. From this 
period she attempted to speak; she moved her lips, but she did not articulate a 
single word. 

The fifteenth day, when she was asked how she had passed the preceding 
night, she took a piece of paper and pencil out of the hands of the interroga- 
tor, and wrote down an answer. She asked at the same time where she was? 
and appeared much astonished on being told that she was in a hospital in Pa- 
ris. During three days she communicated in this way with her attendants. 

On the nineteenth day she was attacked with pain in her back, which be- 

No. XI.— May, 1830. 20 



222 QUARTERLY PERISCOPE. 

coming more vlolent^she uttered a shriek and afterwards exclaimed, ** Ah! 
mon Dieu!" The attendants surprised and frightened, repeated the exclama- 
tion, and ran into the passages and wards, crying the vampire has spoken. The 
patient in her turn appeared equally surprised at what was passing around her; 
her attendants on recovering from their surprise, re-entered her chamber to con- 
gratulate her. She inquired of them what there was extraordinary about her? 
whether she had not spoken before, and said she believed that they had 
been deaf. When her history and appearance were detailed to her, she joined 
heartily in the laugh. 

From this period she continued to speak with facility, and even very agree- 
ably. Her appearance became very pleasant, and her eyes assumed an expres- 
sion of the utmost mildness. She did not recollect any of the circumstances 
which had preceded or attended the disease; not even the shower bath, which 
had produced so violent an effect. 

The sight of her lover, who visited her during her disease, did not produce 
any effect upon the patient; she regarded him at first with fright, as she did 
others. 

The patient remained in the hospital until after her accouchement, when she 
was discharged well. 

12. Intermittent Aphonia. — A very remarkable case of this is related by M. 
Rennes, Professor in the Military Hospital of Instruction at Strasbourg, in the 
Archives G^n^rales, for June last. The subject of the case was a Madame M. a 
brunette, of middle size, aged forty-six, married at the age of twenty, residing 
constantly at her country seat, at Pengord, in the midst of a wood, where the air 
is good, presenting nothing in her physical constitution, or in her character, 
which is extremely cold, that could lead to a suspicion of a predominance of her 
nervous system. Her regimen has always been regular; her life tranquil; she 
never had any violent disease; she has had two children, the youngest is twenty- 
one years of age. This lady was attacked annually, from the age of thirty-three 
years, with aphonia. These attacks were abrupt, and came on at noon, unac- 
companied at first with any local or general uneasiness. The loss of voice was 
sudden and complete, and lasted till midnight of the same day, when speech 
returned in the same rapid manner in which it was lost. This occurred every- 
day for about three weeks, and then ceased. Three of these accessions, each 
of a fortnight or three weeks duration, took place in the course of the first 
year, 1812, and the same course obtained for a few years afterwards. In 1819, 
the periodicity became more regular. Each year, in the month of February, 
the approach of the malady was announced in the morning, by wandering pains, 
shiverings, and horripilations. Exactly at midday the voice became extinct, 
without any affection of the pulse, any sense of constriction about the throat, 
but only a sense of tightness and uneasiness in the epigastric region. She would 
go to bed at nine o'clock, and awake quite well, to go through the same pro- 
cess the succeeding day. Sometimes, however, there were accompanying fe- 
brile symptoms, head-ache, &c. but these were rare. She had no perspiration. 
Nevertheless these attacks diminished her strength, and caused considerable loss 
of flesh. She had been bled — had taken sulphate of quinine, and various other 
medicines, without the least effect. Of late years the duration of these attacks 
has varied from three to seven months every year. The attack over, she regains 
her embonpoint and strength, and appears as if she had never been unwell. 

13. Intermittent Jiphoriia of thirty years standing. — This is related by Dr. 
Oluvieb, of Angers, in the same journal with the preceding case. Maria 
Louisa Girou, midwife at the Hotel Dieu of Angers, aged forty-four, (at the 
period when she came under observation, 1818,) of a nervous and sanguineous 
temperament, delicate constitution, had menstruated regularly from the age of 
fifteen to that of eighteen, when she had profuse menorrhagia, occasioned by 
some violent mental emotions. About this period she became affected for the 



Pathology. 223 

first time, and without any evident cause, with complete aphonia, which lasted 
several days. From this period the complaint came on at irregular intervals — 
sometimes several times in the month — sometimes with intervals of many months. 
She had once an immunity of a whole year. There was no apparent disturb- 
ance of the constitution at the periods of attack. They commenced with 
a sense of irritation in the throat, which gradually increased till the voice was 
totally lost, when the irritation always subsided. During the period of the at- 
tack, the patient felt a sense of oppression about the region of the heart, and of 
heat ascending in currents to the head. In all other respects she was well, and 
went about her avocations as usual. 

From the age of eighteen to that of forty-four years, the attacks of aphonia 
have always presented the same phenomena; but latterly, since menstruation 
has ceased, the intervals between the accessions are longer. Various remedies, 
chiefly of the antispasmodic and tonic kind, had been employed, without mak- 
ing the slightest impression on the malady. At length blood-letting was tried — 
and scarcely had an ounce flowed from a vein when restoration of the voice took 
place. This remedy has invariably produced the same effect in every subse- 
quent attack of aphonia. Leeches gave the same relief, by the time that an 
ounce or two of blood was abstracted. M. Ollivier himself was witness many 
times of this extraordinary efficacy of bleeding. The patient felt as if a load 
were removed from her heart whenever the blood flowed, and then her voice 
was restored. 

14. Case of Sudden Death from Obstruction of the Larynx. — Dr. Senk, of Ge- 
neva, examined, in 1826, the body of a man who died suddenly. This man had 
for a long time lost his voice — had been treated for laryngeal phthisis — been 
able to swallow only liquids — was incapable of supporting violent exercise, and 
finally had for two days complained of his throat. All the viscera were succes- 
sively examined, and excepting venous congestion, and the blood being liquid, 
the consequence of asphyxia, all were found in a normal state, except the la- 
rynx, which presented the following peculiarities: — the glottis was healthy; 
there was a light oedema of the borders of the glottis and of the ligaments of the 
epiglottis; the mucous membrane was tumefied. The larynx having been open- 
ed behind, a tumour became visible, of the size of a filbert, white, hard, fibrous, 
fissured, pediculated, arising from the right ventricle, which it filled, and oc- 
cupying almost the whole of the upper part of the larynx, so that on shutting 
the larynx, a very small crow quill could not be introduced without considera- 
ble effort. This tumour, which Dr. S. thinks syphilitic, was the cause of death. 
The slight tumefaction of the mucous membrane of the larynx being sufficient, 
in the state of the part, completely to close it to the passage of air. — Journal 
des Progres, Vol. XVII. 

15. General Melanosis. — Professor Lobstein, of Strasburg, describes in the 
Repertoire Genirale d'Anatomie et de Physiologie Pathologiques, Tom. VII. the 
following interesting case, in which the disposition to melanosis existed in. many 
of the different textures of the body, and particularly in the skin. Madame S. 
B. aged fifty -four, had, for six years before her death, a black spot on the inside 
of the left leg, at its articulation with the thigh. Gradually the spot became a black 
wart, to remove which various attempts were made by means of ligatures and 
various caustics, but which, notwithstanding all the remedies resorted to, con- 
tinued slowly to increase till in 1827 it attained the size of a hen's e^g. It then 
softened, the skin over it was abraded, fungoid excrescences formed on its sur- 
face, a sanious matter was discharged, and around it arose many small hard tu- 
mours, some of them flesh-coloured, and others bluish, but all indolent and in- 
sensible. By little and little the disease spread on the leg and thigh; and on the 
upper and inner part of the latter a very prominent tumour was produced. The 
liver also became large, and a projection or bump could be felt on its convex 
surface. Towards the end of her life a great number of little tumours of the 



224 QUARTERLY PERISCOPE. 

same colour and hardness with the rest were discovered in the scalp, and one 
arose in the upper eyelid of the left eye, near its inner angle. Meanwhile the 
patient becanne more and more feeble and cachectic, without precisely having 
fever. The discharge from the principal tumour was fetid, and so great, that in 
less than an hour it soaked through twelve folds of cloth. Latterly the prostra- 
tion of strength was such as to render the lady unable to stand. In the three 
last days of her hfe there was no pulsation to be felt in the wrists; the voice was 
lost; and death was preceded by a desire to vomit and eructations. She retain- 
ed her faculties to the very last. 

The original tumour rested on the ligamentous bands and periosteum of the 
parts forming the joint; it consisted of fungoid, reddish lumps, agglomerated, 
and separated from one another by fissures; and it had attained a size consider- 
ably greater than that of an egg. The tumours around it were like large warts, 
reddish-yellow in colour, and as hard as cartilage. They were so numerous, 
that on a piece of skin, measuring three inches by two inches and a half. Pro- 
fessor Lobstein counted sixty-eight, varying from a line to nine lines in dia- 
meter. On a portion of skin from the thigh, measuring six inches by two and a 
half, he found forty-three small medullary tumours, of a flesh-red or bluish co- 
lour, of the hardness of cartilage, and all filled with a black matter. They were 
situated in the true skin and cellular tissue, never penetrated the aponeurosis, 
and were not surrounded by .any sign of inflammation. At the upper and inner 
part of the left thigh, near where the saphena joins the crural vein, there was 
a mass of six encephaloid tumours, the largest of which was ^;wo inches and a 
half long by eleven lines in breadth, and ail of them were softened. The mela- 
notic matter abounded in them all. The vessels behind this mass were not al- 
tered in appearance, except that the coats of the saphena vein were as thick as 
those of an artery. The lungs were crowded with little hard tumours as big as 
lentils, without their parencliymatous structure being diseased. The liver op- 
posite the gall-bladder presented on its convex surface a tumour of the size of 
a small apricot, which contained a homogeneous matter as black as China ink, 
deposited in a soft friable tissue. The spleen contained two tumours, one of 
them eleven, the other seven lines in diameter, and consisting of mixed yellow, 
gray and black matter. The right kidney was healthy in structure, but pre- 
sented at its upper extremity a tumour three inches and a half long, eight 
inches broad, and an inch and three-quarters in thickness, which at first ap- 
peared a semitransparent hydatid, but which proved to be a cyst divided into 
several cells, filled with a black pulpy mass, and having a free communication 
with the renal vein. The great veins of the pelvis were filled with a polypous 
blood adliering to their inner surface. When macerated several days, these 
concretions became fibrine, which in some parts presented a regular stratified 
appearance. 

16. Scirrhus of the Pylorus and Ulceration of the Stomach, without Fain on 
Pressure. — This case is related by Mr. Waldrok, of Bath, in a late Number of 
the Midland Medical and Surgical Reporter, and we are indebted for the follow- 
ing notice of it to the Medico- Chirurgical Review, for January last. The case 
is interesting in several respects, and especially as showing how violent a de- 
gree of inflammation and extensive disorganization may take place in the mucous 
membrane of the intestinal canal, without pain being experienced even on pres- 
sure. Mr. Waldron attempts to explain this absence of pain by the quantity of 
fat on the abdominal parietes, a perfectly gratuitous hypothesis, as is observed 
by Dr. Johnson, who says that he has *'seen the same absence of pain on pres- 
sure where no such condition obtained," and the same has been observed by every 
one of any experience, who has taken the trouble to investigate the subject. The 
subject of this case was a commercial traveller of Bath, aged fifty, addicted'to 
drinkingjSpirits, who applied to Mr. Waldron, Dec. 2d, 1828, with much debility, 
loss of appetite, uneasiness at the pit of the stomach, and frequent vomiting. The 
face was sunk and sallow, the pulse extremely weak, the bowels very irregular. 



Pathology. 225 

Till within the preceding eight months he had enjoyed an uninterrupted state of 
good health. No fulness or tenderness was detected on examining the abdomen, 
and some purgative medicines were prescribed. These, however, failing to effect 
any benefit, Mr. Waldron inquired further, and discovered that the sickness 
generally occurred from an hour and a half to three hours after eating, and that 
the matters brought up were dark-coloured, grumous, and more than common- 
ly offensive; the evacuations were imperfect and scanty, and for some length of 
time a copious and sound stool had not been voided. Calomel and hemlock, 
leeches, and saline aperients were now prescribed, but without any benefit, and 
on the 8th of January, being informed that some difiiculty was experienced in 
administering the enema, Mr. Waldron examined the rectum himself, and by means 
of the stomach-pump, found that some obstruction did exist, though a quantity 
of hardened faeces were brought away. Shortly after this a small bougie was in- 
troduced with some difiiculty, when the patient expressed \nms&\^ greatly re- 
lievedy and the sickness of the stomach quite subsided. The bougie was gradually 
augmented in size, and a pill of three grains of calomel with eight of the pil. 
rhei comp. prescribed with surprising though transient good effect. The pa- 
tient began to sink, became furiously insane, and died on the 10th of February, 
the sickness never having returned since the use of the bougie. 

Sectio Cadaverist forty-eight hours after death. — "I examined the body in the 
presence of Mr. G, Goldstone, surgeon, of this city. Considerable emaciation 
had taken place in the muscles of the extremities; on cutting through the pari- 
etes of the abdomen an unusual depth of adipose matter was found. In the ab- 
domen the vessels of the small intestines appeared dark and congested with 
blood. I passed a ligature in two points above the cardiac extremity of the sto- 
mach, and having divided the part between the ligatures was proceeding to 
trace the stomach downwards to its pyloric extremity, when it broke, and ex- 
travasated its contents into the abdomen. I next separated the small and large 
intestines, following them downwards throughout their whole course. Upon 
laying open the stomach, the cardiac extremity appeared enlarged and thick- 
ened, and the pyloric was a complete mass of disease; at that part where a co- 
noidal opening is formed by the termination of the stomach projecting into the 
duodenum, an enlargement the size of a large duck egg was found: the sto- 
mach above this enlargement was ulcerated and thickened, and appeared as a 
pulpy mass; at the enlargement, the calibre of the part appeared to be nearly 
obliterated, and below it, the duodenum was ulcerated and thickened for se- 
veral inches, and exhibited the same appearance of pulpiness, and was so fra- 
gile as to break upon the sightest force being used. On cutting through the 
enlargement at the pyloric extremity of the stomach, the centre exhibited a 
scirrhous hardness; in one part, there was a dark discolouration, similar to what 
is seen in scirrhous enlargement of the breast, prior to its passing into the ulce- 
rative stage; on cutting into it, a dark coloured sanies escaped, which was im- 
bedded in a tubercular cyst. The rest of the viscera of the abdomen exhibited 
no morbid appearance, excepting the colon and rectum, which were in several 
parts so much contracted, as to reduce the calibre of the intestinal tube to the 
size of the smallest rectum bougie. In the sigmoid flexure of the colon, these 
contractions were very apparent, and the faeces were with considerable diffi- 
culty made to pass these points, by pressing the finger and thumb above, and 
propeUing the fseces forward. 

** When the colon and rectum were laid open, beginning above the left iliac 
region, the intestine appeared in many parts thickened and contracted; in other 
respects no morbid appearance was observed. In the head, the vessels of the 
brain appeared dark and congested with blood; the tunica arachnoidea was very 
much thickened, and had become dense and obscure; in different parts, espe- 
cially on one side, deposits of coagulable lymph were observed; a larger quan- 
tity of fluid than what is common was found in the ventricles; in other respects, 
the brain exhibited no morbid appearances." 

20* 



226 QUARTERLY PERISCOPE. 

17. Case of Ascending Paralysis. — Charles L. xt. 35, robust? and In the mili- 
tary profession for fourteen years, during- which he had served in the Russian 
and Spanish campaigns, and consequently been exposed to great fatigues and 
vicissitudes of climate. In June, 1826, he first perceived that his legs readily 
bent under him, and that he could not easily raise himself up from the sitting 
posture. In other respects he had no complaint. In about a fortnight after this 
he began to feel numbness in his feet, which gradually ascended towards the 
knee. But while the surface thus lost its sensibility, the muscles beneath be- 
came the seat of acute pain, which was much exasperated by pressure. He had 
been a month confined to bed in this state, with nearly loss of all power in the 
lower extremities, when he perceived a numbness invade his hands. The pro- 
gress was exactly similar to that in the inferior members; and he was seen by 
the narrator on the 22d of September of the same year. He was now (Complete- 
ly paralytic, excepting the tongue, the face, and the neck. These last became 
gradually affected. He had never complained of pain in his head, not* of any 
part of the spine; nor did the most rigid examination detect any physical lesion 
in this last region. His general health was good — his intellects perfect. He at- 
tributed his disease to rheumatism, contracted during his bivouacs in Spain. 
He made water voluntarily, and had a daily evacuation from the bowels. He 
slept and ate well. The skin was nearly of natural temperature, but quite in- 
sensible to pinching or pricking. Any pressure of the muscles, on the other 
hand, gave him great pain, and caused him to cry out. 

Frictions of lytta and alcohol were assiduously employed along the spine — 
ammoniated liniments were applied to the limbs, and cinchona, with wine, 
was liberally exhibited internally. In the course of a fortnight the sensibility 
of the skin began to return and that of the muscles to diriiinish. The power 
of the muscles also gradually returned, but inversel}^ to the way in which it 
had been lost — namely, from above downwards. He was never able, how- 
ever, to raise himself up on his feet. This amelioration continued but for a 
very short time, and he was soon as bad as ever. Blisters along the spine 
were added to the former measures. On the 3d of November he became sud- 
denly incommoded in his brealhing — his pulse quickened — his countenance 
became anxious — he had cough — the intercostal muscles seemed scarcely to 
move. In this state he lingered till the 7th of the same month, when he ex- 
pired without any struggle. 

Dissection. The spinal canal was opened throughout its whole extent. 
There was very little blood in the venous sinuses. The dura mater in its na- 
tural state. The pia mater was sprinkled with calcareous depositions in the 
lumbar region, and was finely injected. The roots of the lumbar and sacral 
nerves, as also the great sciatic, were injected with black blood. The other 
nerves were very minutely examined; but nothing particular was observed. 
The spinal marrow was rather firmer than natural, and the same might be 
said of the medulla oblongata and brain. The lungs were filled with tuber- 
culous matters, and there v/ere some small abscesses. The heart was empty 
and flaccid. The whole of the abdominal viscera were sound. The muscles 
presented no appearance different from those of a person in health, except 
being more pale and flaccid.— Jfei/. Chirug. Rev. Jan. 1830, from La Clinique. 

18. Case of Disease of the Processus Dentatus. — ** A gentleman aged 22, of a 
scrofulous habit; in the early part of his life had suffered amputation on ac- 
count of a disease of the knee, and afterwards was liable to pectoral complaints 
with hsemoptysis. In the beginning of the year 1828, he began to complain of 
pain and stiffness of the neck, referred chiefly to the left side of it, and much 
increased by the motion of the head. The pain sometimes extended into the 
larynx, and backwards towards the scapula. After considerable relief from re- 
peated blistering, &c. the symptoms returned, accompanied by loss of appetite, 
frequent pulse and night perspirations; and soon after this he became affected 
with difllcult deglutition, some dyspnoea and hoarseness. There was now also 



Pathology. 227 

severe fixed pain l-eferred to the back of the head, and much increased 
by the motion of the parts? so that he was obhged to support his head with 
both his hands when he had occasion to make any change of his posture. He 
was next affected with paralysis of the tongue and the upper eyehd of the left 
side. On the 16th January, 1829, he was seized with paralysis of the left arm, and 
two days after the right was affected in the same manner. He had then great 
pain and difficulty in passing urine, with obstinacy of the bowels, which 
nothing could overcome. On the 29th, the lower extremities became paralytic, 
and he died on the 31st, having suffered greatly on the day on which he died, 
from difficult breathing. 

^'Inspection. — All the external parts of the neck, the pharynx, &c. were 
healthy, and no disease was discovered in any of the vertebrae in their external 
aspect. The brain and cerebellum were healthy, except some increase of 
vascularity. Within the foramen magnum, and attached to the inner surface 
of the dura mater at its interior and lateral parts, there was a spongy tumour 
of a grayish-yellow colour, which, when cut into, presented a variegated struc- 
ture, resembling fungus hsematodes. The processus dentatus was rough and 
carious on its surface, and it was so much elongated as to project half an inch 
into the cavity of the cranium. Its ligaments also were partially destroyed so 
as evidently to allow it to encroach upon the area of the spinal canal, and to 
compress the cord. The spinal cord at the upper part was flattened, but not 
materially altered in its texture." — Mercrombie on the Brain. 

19. Paralysis of the Muscles of one side of the Face from disease of the Portio 
Dura. — Mr. Abekcrombie, in his work on the brain, makes the following very 
interesting observations on this affection; they merit the attention of the pro- 
fession. We have seen very many cases of this complaint, the pathology of 
which is not generally understood, and have seen one case at least in which it 
was rendered permanent by mal-treatment. "The important practical application 
of the discoveries of Mr. Bell," says Mr. Abercrombie, "is, that there may be 
paralysis of the muscles of one side of the face, producing distortion of the 
mouth with inability to shut the eye-lids, without disease of the brain, and con- 
sequently without danger. This affection depends upon a disease limited to 
the portio dura of the seventh nerve, and may be produced by inflammation 
of the ear or the parotid gland, or tumours compressing the nerve on any part 
of its course. The most common example of it seems to originate in a kind of 
rheumatic inflammation produced by cold, especially by exposure to a current 
of cold air, as when a person has sat long, or has slept opposite to an open 
window, or has sat in a carriage with a cold wand blowing on one side of his 
head. It is to be treated chiefly by local remedies, as topical bleeding, blis- 
tering, and the application of warm water or steam. In this manner it is often 
speedily removed, but in some cases proves tedious, and does not go off en- 
tirely for several months. The affection is of course still more untractable, or 
even permanent, when it depends upon a permanent cause, such as tumours 
compressing the nerve, or destruction of a portion of the nerve by wounds or 
extensive suppurations. There is also a very formidable modification of it 
which depends upon disease of the temporal bone. 

*'The character by which these cases are distinguished from paralysis de- 
pending upon disease of the brain, consists chiefly in the sensibility of the 
parts remaining unimpaired. The loss of motion also is confined to the mus- 
cles of the face and eyelids, and does not affect those of the jaw. These pecu- 
liarities arise from the remarkable facts discovered by Mr. Bell, Mr. Shaw, 
Mr. Mayo, and others, that the portio dura of the seventh is a nerve of motion 
only, supplying the muscles of the face and the orbicularis of the eye, but not 
the muscles of the jaw; and that the sensibility of all these parts, and the 
motion of the muscles of the jaw are derived from the fifth, which, having a 
double origin, is a nerve both of sensation and motion. An important distinc- 
tion, however, is to be kept in mind in regard to the paralysis of the eye-fids 



22S QUARTERLT PERISCOPE. 

which occurs in these cases, namely, that it is the inability to shut the eye 
that arises from the affection of the portio dura of the seventh. The dropping 
of the upper eye-lid and inability to raise it, is a disease entirely of a different 
nature; it depends upon an affection of the third nerve, and consequently gives 
more reason to suspect disease within the head. 

"When therefore we find paralysis and distortion of the face, with loss of 
sensation of the parts, we have reason to suspect disease within the head, the 
portio dura of the seventh and the fifth being both affected. But when we 
have the paralysis without diminution of sensation, the disease depends upon 
an affection of the portio dura alone, and may be entirely without danger. 
Such cases however are not to be treated lightly, but the cause of them ought 
to be carefully investigated; for if there be any reason to suspect that the affec- 
tion depends upon disease of the temporal bone, it may come to be attended 
with danger by inflammatory action spreading inwards to the dura mater or 
brain. There is another modification also which requires to be watched with 
anxiety, namely, when the affection is accompanied with deafness; as this gives 
reason to believe that both portions of the seventh nerve are affected, and 
consequently to suspect an internal cause." 

20. Organic Lesions produced by the Hydrocyanic Acid. — M. Orfila, in his 
toxicology, gives an instance of inflammation of the mucous membrane of the 
stomach and intestines in an individual who had been destroyed by this acid; 
but the same appearance has never been observed in dogs, probably from the 
poison having induced death in them so rapidly, as not to allow time for the 
production of inflammatory action. In the autopsic examinations made by MM. 
ADELoivr, Marc, andMAKJOLiN, of seven persons who had been destroyed by this 
poison, the same marks of inflammation, though in different degrees, were ex- 
hibited in every instance. Besides the inflammation of the mucous membrane 
of the stomach and intestines, the texture of the spleen was softened, and in 
some reduced to nearly a pultaceous mass; the hepatic veins engorged with 
fluid black blood, and the kidneys of a deep violet, engorged with blood, soft, 
and allowing the exterior membrane to be readily detached from its parenchy- 
ma. The heart and large arteries were empty, and of firm texture, while the 
large veins were filled with black fluid blood, which exhibited no where the 
least trace of coagulation. The mucous membrane of the larynx, trachea, and 
bronchia were of a deep red, which could not be effaced by washing, and the 
bronchia throughout were surrounded by a bloody frothy fluid. The mem- 
branes of the brain were injected, the sinuses of the dura mater engorged with 
black fluid blood, and the substance of the brain and spinal marrow somewhat 
softened, but otherwise natural in appearance. No part of the body exhaled 
the odour of bitter almonds, nor exhibited any signs of putrefaction, but in every 
instance there was considerable cadaveric rigidity. The mucous membrane of 
the bladder, pharynx, and oesophagus seemed natural and healthy. — Archives 
Generalesy July, 1829. 

21. Mental Derangement from Gastric Irritation, — Cases of this description 
are not, we suspect, rare; the following, however, related by H. Wouship, Esq. 
in the London Medical Gazette for December last, is not without interest. *' Ed- 
mund 5 aged 15, but not yet arrived at puberty, of small stature, but re- 
gularly formed, with light-coloured hair, delicate and pale skin; and an active 
and intelligent mind, was put under my care for an affection of his eyes, which 
presented the following appearances: — There is in each eye a pencil of red ves- 
sels, running from the external and internal angle, and terminating at the mar- 
gin of the cornea, which is perfectly transparent; the pupil is large and regular; 
the iris acts slowly and almost imperceptibly when a strong light is admitted to 
the eye, and the pupil becomes contracted only when the sight is fixed on 
any particular object; the conjunctiva of the lids inflamed, and there is lachry- _ 
mation and confusion of vision when an object is regarded for any length of 



Pathology, 229 

time. The upper eyelid is large from the number and size of its vessels. He 
has been subject to similar attacks from time to time during* the last four or 
five years, and has lately been under the care of a celebrated oculist, who has 
advised the application of leeches, and an occasional dose of calomel, to be fol- 
lowed up with senna and salts. 

His mother informed me that he was not sound in his mind; and with respect 
to this point, I made out the following history: — About two years since he was 
the subject of scarlet fever, which ran rather high. He had passed nearly a week 
in convalescence from the attack, when he was seized with acute pain in the 
abdomen, followed by purging and vomiting, which continued for some hourso 
It was then his mind became affected; he screamed, and made such exertions, 
that he was with difficulty kept in his bed; he fancied he was going to be mur- 
dered, and pointed at the imaginary objects which were to destroy him. He 
would minutely detail many absurd stories, of which he had no memory when 
subsequently questioned. From this state he passed into one nearly resem- 
bling idiotism, and then gradually recovered. Although occasionally irritable, 
he has had no attack like the one I have just described till within a short time 
of my attendance, nor was this attack of so severe a character as its predecessors. 

Disregarding for a time the affection of the eyes, and bearing in mind the his- 
tory of the former illness, I was induced to look for the cause of the present re- 
lapse in a disorder of the stomach, or some other abdominal viscus. That such 
a disorder existed, and that the treatment I adopted for its removal acted bene- 
ficially on the brain, the following statement will fully prove. 

Nov. 3d. — My patient complains of great pain and heat in the head, with 
confusion of ideas. His pulse is quick and full; respiration short, and princi- 
pally carried on by the ribs. He sighs continually; his digestion is painful, and 
his appetite immoderate, for scarcely does half an hour elapse after eating 
a meal, which would satisfy two persons, when he again calls for food, and eats 
to a like excess. The tongue is covered with a white fur; the bowels are irre- 
gular; the epigastrium is full and hard, and painful on pressure. He was put 
on low diet, with lemonade for drink; leeches, followed by poultices, were ap- 
plied to the pit of the stomach on the 3d, 4th, and 8th; the leeches amounted 
in all to 40. To the treatment just mentioned, my patient added the occasional 
use of a foot-bath. 

Nov. 14th. — His recovery has been as rapid as I could have wished: at the 
time I am writing, his tongue is clean, his head clear; the pain in the epigas- 
trium no longer exists, and the inflammation of the eyes has quite disappeared, 
so that, he says, his sight is as good as ever it was. 

22. Hallucinations. — M. Blaij-d divides hallucinations into — 1st, those which 
depend on the sensitive apparatus, as for example in icteric persons, who see 
objects of a yellow tinge — 2d, those which arise from an affection of the brain, 
as where there occurs pathologically a functional condition, similar to that which 
in a normal state produces real perceptions: these hallucinations are observed 
in mania, in which the maniac perceives objects, which although having a real 
existence, are not presented to his external organ of vision — 3d, those which 
depend upon lesion of an abdominal or thoracic viscus, 8cc. ; such is the deli- 
rium which occurs in gastro-enteritis and pneumonia — 4th, those which are pro- 
duced by exaltation of the imagination, as ecstacy and violent passions. The hal- 
lucination of the sensations are, according to M. B. the easiest to cure. When 
those which depend on an affection of the brain are slight or recent, they yield 
easily to antispasmodics; but if they are violent, and if there be great cerebral 
lesion, they are the prelude to mania. The violence of those which are sym- 
pathetic is proportioned to the affection from whence they emanate. Those 
produced by exaltation of the imagination are to be cured by a moral treatment. 
— Nouvelle Bibliotheque Medicale, Sept. 1829. 

23. Hallucination of Hearing. — M. Bland relates in the Nouvelle BiblioiMque 



230 QUARTERLY PERISCOPE. 

Medicale for September last, a very curious case of this description. A girl aged 
10, was in the fields not far from home, when she suddenly heard herself call- 
ed in a strong", solemn voice, and the sound of other words which she could not 
understand. She ran home trembling and sought refuge with her mother, who 
supposing that some one of the neighbours had tried to frighten the child, 
endeavoured to encourage her, and afterwards went out of the house to reproach 
the unknown person for their imprudence; but she was soon recalled by the 
cries of her child, who heard again the same voice. Frightened herself at this 
occurrence, which ske could not understand, she knew not what to do; she 
could not conceive how her child could hear sounds which she could not. The 
next day the child was in perfect health, but on the succeeding one she heard 
the same voice many times; this voice called her always distinctly by name, in a 
strong and very solemn tone. After being in this condition fifteen days, she was 
placed under the care of M. Bland, who found all the functions in a perfectly 
normal condition, except that of hearing. Ordered the child to take pills of 
exti'act of valerian, castor, flowers of zinc, and aqueous extract of opium, and 
in a few days she was perfectly well. 

24. Hallucination of Vision. — This case is also related by M. Bland, in the 
same journal from which we have taken the preceding. The subject of it was 
a very nervous woman, who had enjoyed very good health until the age of fifty- 
six. At this period she was very much excited from seeing her husband in an 
epileptic fit, but soon recovered her usual health. A short time afterwards, 
however, she had some febrile symptoms, and was subsequently painfully af- 
fected in the following manner: — Atriight she awoke suddenly from sleep, and 
saw frightful objects, monsters of all sorts, spectres bearing coffins. In extreme 
agitation she arose quite bewildered, lighted her lamp, and then the spectres 
disappeared. During the day she remained quiet and undisturbed. These 
hallucinations continued during more than two months, presenting some varia- 
tions. The health of the patient was much changed when she applied to M. 
Bland, who prescribed a decoction of antispasmodics, and this condition 
ceased. 

25. Hallucination of Touch and Hearing. — A third case of hallucination is pub- 
lished by M. Blakd, in the journal already cited, in which there was hallucina- 
tion both of the touch and hearing. It occurred in a female, 35 years of age, 
very sensitive, very irritable, exceedingly nervous, subject to gouty rheumatic 
pains, who became violently angry on the evening of the 25th of July, 1828. 
At night she was agitated, and awoke suddenly from sleep. All at once she 
thought that she felt her right hand strongly clasped in the hand of some one, 
and heard near her ear a low voice; she arose from bed much frightened, utter- 
ed piercing cries, and a pain which she felt in the back of her right hand at the 
articulation of the third metacarpal bone with the first phalanges of the middle fin- 
ger, where there was some redness and swelling, strengthened the patient in her 
illusion. She passed all the morning in extreme agitation, with uneasiness, 
anorexia, fever, &c. and when she applied to Dr. Bland, he had much difficulty 
in persuading her that the pain which she felt was only rheumatic gout, which 
she had so frequently experienced, and that the voice was an illusion. She, 
however, gradually became calm, and was restored to her usual health. 

26. Affection of the Brain from a Fall, with retention of urine. — Dr. Johx 
Abekcrombie in his valuable work on the diseases of the brain and spinal cord, 
relates the following interesting case. " A servant girl aged about twenty, 
fell backwards with a child in her arms, and received the full force of the fall 
upon the most prominent part of the occipital bone. She soon recovered from 
the immediate effects of the injury, but continued to have pain in the part; 
and after several months, was seized with paraplegia and retention of urine. 
She was now confined to bed for three or four months, after which she re- 



Pathology, 231 

covered the use of her limbs, in a tolerable degree, bat the retention of urine 
continued, and she came to Edinburg-h in the beginning of 1828, which w.as 
more than a year after the accident. The paraplegia was now nearly removed, 
but she had still retention of urine, requiring the constant use of the catheter. 
On the seat of the injury on the occipital bone, a round portion, the size of a 
crown piece was acutely tender, and very moderate pressure upon it produced 
complete insensibility, which continued a minute or two, and returned as often 
as the pressure was repeated. It had the appearance of syncope, but the pulse 
was not affected. In this state I saw her, along with Mr. Lizars, and it was 
agreed to make a free crucial incision through the part, and to keep the wound 
open by dressings so as to promote suppuration. In doing so the pericranium 
was found tender^ and somewhat thickened, but the bone was sound. On the 
following day she passed her urine freely, and she continued free from com- 
plaint as long as the wound continued to discharge. It healed at the end of a 
fortnight, and the retention of urine returned immediately. The incision was 
now repeated with the same result as before, her urine being freely passed al- 
most immediately. Various means were then employed to promote a more 
complete suppuration from the wound, but it healed after two or three weeks, 
and the retention returned as before, with considerable tenderness in the af- 
fected spot. A third incision was then made with the same effect as before, 
and various applications were made with the view of promoting exfoliation of 
bone, as in Sir E. Home's cases, but without success, and the wound again 
healed after three or four weeks. The fits of insensibility on pressure now 
returned, which had not returned after the former incisions, and along with 
them the retention of urine. 

" Since that time repeated incisions have been made with similar results. 
The principal change in her situation now is, that she has got free of the fits 
of insensibility upon the spot being pressed; and the effect of the incisions has 
continued longer, as on several occasions she has remained free from the reten- 
tion of urine for several weeks after the incisions were healed, and at one time 
enjoyed perfect health for three months." 

27. Affection of the Brain with retention of urine^ followed by Anasarca and 
Paralysis. — The following case is related in the London Medical and Surgical 
Journal for November last. ** E. G. aged eighteen, of a leucophlegmatic habit, 
of excellent general health, the digestive and uterine functions natural; com- 
plained of intense pain in the right temple, which arose without any evident 
cause. She was ordered purgatives, arteriotomy, and cold lotions to the head. 
These remedies had the best effects, but the next day the pain was violent in 
the other temple, and she earnestly requested the performance of arteriotomy; 
which again afforded immediate relief. In a few days she experienced a re- 
currence of pain in the occiput, for which cupping was successfully employed, 
and the bowels duly evacuated. All pain in the head was removed, but she 
could not evacuate the bladder. She remained in this condition for three 
months, and required the use of the catheter twice and thrice daily. Her ap- 
petite was natural, the uterine secretion healthy. The urine was clear, limpid, 
and considerably increased in quantity. She never experienced the slightest 
symptom of hysteria, prior or subsequent to the disease. She had no perspira- 
tion during her illness. When the vicissitudes of the weather were consider- 
able, she often required the catheter earlier than the ordinary visit; and if not 
employed she experienced much pain from the distention of the bladder, which 
she successfully relieved by copious libations of common gin. On one occa- 
sion she had taken half a pint of that liquor, though the bladder was distended 
to an immense size, for it extended nearly to the epigastrium. The catheter 
was employed, and a large wash-hand basin full of urine drawn off. She fre- 
quently relieved her pain by the spirituous potation. Several medicines were 
exhibited, especially those recommended Sir Astley Cooper, in paralysis of the 
bladder, but all in vain. Blisters were applied to the sacrum, an open cathe- 



232 QUARTERLY PERISCOPE. 

ter left in the bladder for hours daily, and all in vain. At length the pain In 
the temple returned, and the retention of urine ceased. The pain, however, 
coAtinued so violently as to induce wandering and slight delirium, when the 
arteriotomy was again resorted to, and with perfect success, but the retention 
of urine returned. She became weary of confinement to her apartment, and 
in open defiance to advice, went out in a cold day to visit an acquaintance. 
Next day the abdomen was tumid, and evident sense of fluctuation was appa- 
rent, even after the use of the catheter. General anasarca now supervened, 
and the catheter was no longer necessary. By the usual diuretic and purga- 
tive treatment her dropsical symptoms disappeared, and she was restored to 
perfect health. Several practitioners witnessed the progress and treatment of 
this case. About six months after her recovery, the right arm became paraly- 
tic, which was ultimately restored by vesication on the neck, as near the 
origin of the brachial nerves as possible." 

28. Softening of the Spinal Cord. — ** A gentleman, aged 42, in October 1827 
began to be affected with pain in the lower part of tVie back, stretching round 
the abdomen, and frequently shooting into the groins. After a short time this 
was succeeded by coldness and numbness of his feet, which gradually extend- 
ed upwards with diminished power of motion, until, after several weeks, it ter- 
minated in perfect loss of motion of both lower extremities, with retention of 
urine. There was pain in some parts of the affected limbs, and in others a 
painful sensation of cold. This perfect loss of power continued five or six 
weeks, when, after a great deal of treatment by cupping, blistering, &c. he re- 
covered a slight degree of motion, but no power of the bladder. He then be- 
gan to be affected with spasms of the muscles of the back and abdomen, with 
a very uneasy sensation of tightness across the abdomen, and at times across 
the lower part of the thorax. The spasms occasionally assumed the characters 
of opisthotonos, and at one time he had almost incessant hiccup, which con- 
tinued in a most violent degree for several days. After the employment of 
various antispasmodics, this subsided under the use of musk. During the 
course of these symptoms, he frequently complained of pain in various parts of 
the spine, at first in the lower part, and afterwards higher up; and the feeling 
of numbness extended gradually upwards, till it reached nearly the upper part 
of the dorsal region, and was felt in a very considerable degree along the sides 
of the thorax. 

*' After this he became liable to feverish attacks at night, terminat- 
ing in the morning by very profuse perspiration, but this was strictly con- 
fined to the parts which were not palsied, and there never was the smallest 
moistui'e on the lower extremities. He had, also in the upper extremities, a 
frequent feeling of intense heat, while the lower continued cold and benum- 
ed. During this time a considerable, but very imperfect degree of motion 
continued in the lower extremities, but the bladder continued entirely 
paralytic. 

*' In April, 1828, he went to the country, and at this time he had such a 
degree of motion as to walk a little on a smooth garden walk, leaning on two 
persons, or supported by crutches. But soon after this he began to com- 
plain of pain in the head. It occurred in irregular paroxysms, and was often 
refen'ed to a small defined spot, on various parts, especially behind the ear, 
and sometimes to the tip of the ear. This pain seemed to abate under the use 
of arsenic; but soon returned, and became more fixed and permanent, and the 
palsy of the limbs again increased. After an absence of about two months, 
he returned to town in the beginning of July. At this time the head-ache was 
severe, and the power of the limbs so much impaired, that he was entirely 
confined to bed. In a few days after his return, the right arm became paraly- 
tic, and his speech considerably impaired. After a day or two, these symp- 
toms rather subsided, but in the following night he became comatose and died 
in the afternoon. There never was complete loss of sensation of the affected 



Pathology. 233 

limbs; he had only complained of it occasionally at particular spots, and of a 
g-eneral feeling- of numbness and coldness. 

'■^Inspection. — There were some scales of bone attached loosely to the inner 
surface of the dura mater of tlie spinal cord. The whole cord was of a pale 
rose colour, and in a state of complete ramollissement through its whole extent, 
being- in every part entirely diffluent. The medulla oblongata was tolerably 
healthy, except a slight degree of softening on its anterior part; and there was 
also a degree of softening on the tuber annulare, which seemed to involve the 
origin of the fifth nerve. Beyond this, the ramollissement became again more 
decided, extending along the crura cerebri and cerebelli, and considerably into 
the substance of the brain, at the part adjoining the crura. The brain, in 
other respects, was healthy, and there was no effusion in the ventricles. 

"It is difficult to trace the precise nature and progress of the affection of the 
cord, when the disease advances in so gradual a manner as in this case, and 
terminates in disorganization so complete and extensive. In tracing the his- 
tory of the analogous disease of the brain we found reason to believe, that it is 
originally an inflammatory affection of a low chronic character, seated in a 
small part of the cerebral substance; that it may continue for a considerable 
time in the state of simple inflammation, and then subside; or that it may ter- 
minate by a permanent change in the structure of the part, generally with 
some degree of induration. In this state we find it when the patient dies of 
another disease. When it is itself the fatal disease, it seems to be so by pass- 
ing either into ramollissement, or into partial and unhealthy suppuration. It is 
probable that the same character of disease takes place in the spinal cord; and 
it is found, in the same manner, sometimes in a state of ramollissement, some- 
times in the state of induration, and sometimes one part is found indurated and 
another softened. In a remarkable case communicated to Dr. Ollivier by An- 
dral, the affection began with numbness of the forefinger of the left hand, 
which gradually extended over the hand and arm. After some time the other 
hand and arm became affected in the same manner, and, after a year, the lower 
extremities. All the limbs then became paralytic, with permanent contraction, 
but without loss of feeling. The legs were bent upon the thighs, and the 
thighs upon the abdomen, and the arras rigidly fixed across the thorax, with 
the points of the fingers pressed against the palms of the hands. If attempts 
were made to move the limbs from these positions, they were thrown into 
spasmodic contractions with much pain. The patient died in this state at the 
end of eighty days from the commencement of the disease. Along nearly the 
whole length of the cord, there was a central cavity full ofa soft gray mucus. It 
was considered as arising from ramollissement of the gray central matter of the 
cord, and the parietes of the cavity were formed by the white matter in a 
healthy state. In a case by Ollivier, in which palsy took place in the same 
gradual manner, but affected only the lower extremities, the patient was con- 
fined to bed for seven years. His legs were drawn up upon his body, and were 
entirely motionless, but preserved their feeling. There was extensive ramol- 
lissement of the anterior pillars of the cord: and a very remarkable circum- 
stance was, that the softening was greatest in the upper parts of the cord, the 
corpora pyramidalia, and several parts of the brain, and became less towards 
the lumbar portion. The intellectual faculties had been almost entirely obli- 
terated, but the motion of his arms continued entire to the last. Such are the 
difficulties and obscurities of this interesting subject." — Abercrombie on the 
Brain. 

29. Cause and Treatment of Stuttering. — We extract the following observa- 
tions on this subject from the fourth edition of the valuable Elements of Physics ^ 
by Dr. Arnott, a work that should be attentively studied by every medical 
student. "The most common case of stuttering," says Dr. A. *'is not, as has 
been almost universally believed, where the individual h^ts a difficulty in re- 
spect to some particular letter or articulation, by the disobedience of the parts 

No. XL— May, 1830. 21 



334 QUARTERLY PERISCOPE. 

of the mouth which should form it to the will or power of association, btit 
where the spasmodic interruption occurs altogether behind or beyond the 
mouth, viz. in the glottis, so as to affect all the articulations equally. To a per- 
son ignorant of anatomy, and therefore knowing not what or where the glottis 
is, it may be sufficient explanation to say, that it is the slit or narrow opening 
at the top of the windpipe, by which tlie air passes to and from the lungs, be- 
ing situated just behind the root of the tongue. It is that which is felt to close 
suddenly in hiccup, arresting the ingress of air, and that which closes to 
prevent the egress of air from the chest of a person lifting a heavy weight, or 
making any straining exertion; it is that also, by the repeated shutting of which 
a person divides the sound in pronouncing several times, in distinct and rapid 
succession, any vowel, as o, o, o, o. Now the glottis during common speech 
need never be closed, and a stutterer is instantly cured, if by having his atten- 
tion properly directed to it, he can keep it open. Had the edges or thin lips 
of the glottis been visible, like the external lips of the mouth, the nature of 
stuttering would not so long have remained a mystery, and the effort necessary 
to the cure would have forced itself upon the attention of the most careless ob- 
server: but because hidden, and professional men had not detected in how far 
they were concerned, and the patient himself had only a vague feehng of some 
difficulty, which, after straining, grimace, gesticulation, and sometimes almost 
general convulsion of the body, gave way, the uncertainty with respect to the 
subject has remained. Even many persons who by attention and much labour 
had overcome the defect in themselves, as Demosthenes did, have not been 
able to describe to others the nature of their efforts, so as to insure imitation: 
and the author doubts much whether the quacks who have succeeded in re- 
lieving many cases, but in many also have failed, or have given only temporary 
relief, really understood what precise end in the action of the organs their im- 
perfect directions v/ere accomplishing. 

*' Now a stutterer, understanding of anatomy only what is stated above, will 
comprehend what he is to aim at, by being fartlier told, that when any sound 
is continuing, as when he is humming a single note or a tune, the glottis is ne- 
cessarily open, and therefore, that when he chooses to begin pronouncing or 
droning any simple sound as the e of the English word berry, (to do which at 
once no stutterer has difficulty,) he thereby opens the glottis, and renders the 
pronunciation of any other sound easy. If then, in speaking or reading, he 
joins his words together, nearly as a person joins them in singing, (and tiiis may 
be done without its being at all noted as a peculiarity of speech, for many per- 
sons do it in their ordinary conversation,) the voice never stops, the glottis 
never closes, and there is of course no stutter. The author has given this les- 
son, with an example, to a person, who before would have required half an 
ho\ir to read a page, but who afterwards read it almost as smoothly as was pos- 
sible for any one to do; and who then, on transferring the lesson to the speech, 
by continued practice and attention, obtained the same facility with respect to 
it. There are many persons not accounted peculiar in their speech, who, in 
seeking words to express themselves, often rest between them on the simple 

sound of e mentioned above, saying, for instance, hesitatingly, *' I e think 

e you may," — the sound never ceasing until tlie end of the sentence, how- 
ever long the person may require to pronounce it. Now a stuttererj who, to 
open his glottis at the beginning of a phrase, or to open it in the middle after 
any interruption, uses such a sound, would not even at first be more remarkable 
than a drawling speaker, and he would only require to drawl for a little while, 
until practice facilitated his command of the other sounds. Although producing 
the simple sound which we call the e of herry, or of the French word fete, is a 
means of opening the glottis, which by stutterers is found very generally to an- 
swer, there are many cases in which other means are more suitable, as the in- 
telligent preceptor soon discovers. Were it possible to divide the nerves of 
the muscles which close the glottis, without at the same time destroying the 
faculty of producing voice, such an operation would be the most immediate 



Materia Medica. 235 

«nd certain cure of stuttering"; and the loss of the faculty of closing the glottis 
would be of no moment. 

" The view given above of the nature of stuttering" and its cure, explains the 
following facts, which to many persons have hitherto appeared extraordinary. 
Stutterers often can sing well, and without the least interruption — for the tune 
being continued, the glottis does not close. Many stutterers also can read 
poetry well, or any declamatory composition, in which the uninterrupted tone 
is almost as remarkable as in singing. The cause of stuttering being so simple 
as above described, one rule given and explained may, in certain cases, instant- 
ly cure the defect, however aggravated, as has been observed in not a few in- 
stances; and this explains also why an ignorant pretender may occasionally suc- 
ceed in curing, by giving a rule of which he knows not the reason, and which 
he cannot modify to the peculiarities of other cases." 



MATERIA MEDICA. 

30. On the Action of Stramonium. — According to Dr. Amelu:ng, the first effect 
produced by the internal administration of stramonium in small doses, is a re- 
markable dryness of the mouth and throat. The voice becomes a little hoarse; 
the head is afterwards more or less affected, according to the dose that has been 
taken; the intellectual faculties become a little obtuse; there is a lassitude and 
weakness of the limbs, though the patient does not experience any particular 
weakness; there is no disposition to sleep, nevertheless the stramonium pro- 
duces agreeable dreams, like opium; in small doses, it does not affect the appetite: 
in larger doses it diminishes it; the salivary and urinary secretions are augment- 
ed; by this latter effect, the stramonium approaches in properties the digitalis 
purpurea; this analogy becomes stronger again by the sedative action that the 
stramonium exercises on the sanguineous circulation. In a small dose, the stramo- 
nium augments at first the activity, but its prolonged use diminishes the circula- 
tion; its effect is slower, but more certain, than that of the digitalis; it does not 
disagree with the stomach, and does not produce so prompt a loss of muscular 
power; finally its prolonged use does not produce so readily symptoms of poi- 
soning as the digitalis. The great disposition to haemorrhages which is observed 
in subjects poisoned by stramonium, the very prompt putrefaction of their bo- 
dies, indicate a powerful depressing action on the vital powers, and authorize 
the arranging this article with the digitalis and hydrocyanic acid, in the class 
of those which considerably diminish the oxygenation of the blood. — Bull, des 
Sc. Med. June, 1829, from Hicfeland's Journal, Nov. 1828. 

31. Properties of the Hydrocyanic Syrup of the French Codex. ByM. Ohfiia. 
— This syrup contains one part of the medicinal hydrocyanic acid, of specific 
gravity of 0.9 to nine parts of syrup. Two drachms of it in four ounces of wa- 
ter will kill a robust dog in fifteen to eighteen minutes, and the same quantity 
given to several adult persons, destroyed life in forty minutes. This syrup in 
a short time undergoes the same alterations as the pure acid, first becoming of 
a yellow colour, then brown, and finally blackish; whereas, if a syrup be made, 
containing only one-thirtieth of the acid, it undergoes alterations much more 
slowly, and retains its colour at the end of ten months. — Archives Gen6rales, 
July, 1829. 

32. On Vegeto-Alkaline Poisons, and the Neutralization of their Power.— In a 
memoir read by M. Donne to the Academy of Sciences, he states, that morphia, 
brucia, strychnia, &c. combine with chlorine, iodine, and bromine, to form dis- 
tinct compounds. These are true chlorides, iodides, and bromides, and may be 
decomposed by the acids, and the vegeto-alkalies separated. It appears also 



236 QUARTERLY PERISCOPE. 

that these compounds are innocuous in comparison with their bases, and that 
the compounds of strychnia, when given in doses of two and a half grains, pro- 
duced no effects on a dog*, whilst half a grain of pure strychnia killed a dog of 
much larger size. 

Experiments were then made to ascertain the power of chlorine, iodine, and 
bromine, as remedies against the poisonous properties of the substances men- 
tioned;. and it was found, that if any of these substances were injected into the 
stomach after strychnia, and in such period of time as had not allowed of suffi- 
cient absorption of the latter to produce death, then harm was prevented. In 
seven experiments of this kind, where doses of one and two grains of veratria 
had been given, the animals were saved from death by administering tincture 
of iodine. Once death took place when the antidote was given eight or ten mi- 
nutes after the poison; and in another case the tincture of bromine given im- 
mediately after the administration of a grain of strychnia, failed to save the ani- 
mal. 

AVhen the innocuous compounds of strychnia were decomposed by sulphuric 
acid, and the sulphate formed given to a dog, it killed him in less than an hour. 
Most of these compounds crystallize regularly, and have particular characters. 
They are all decomposed by acid. — Brandt's Quarterly Journal, Jan. 1830, 
from Bull. Univ. c. xviii. 

33. Medicinal properties of the Cai'nga. — In our second volume, p. 431, we 
announced the introduction of this plant into the materia medica, by Von Langs- 
dorf. This remedy is now attracting some attention in Europe, and MM. Pelle- 
tier and Caventou have recently presented a report in relation to it, to the Royal 
Academy of Medicine. This medicine is derived from the Chiococca anguifuga. 
The bark of the root is represented as very uncertain in its effects; but the wa- 
tery extract, on the contrary, is very constant in its operation, in doses of from 
twelve to twenty grains. It is, however, rather slow in producing its effects, 
and requires, sometimes, to be given in larger doses, so as to make a decided 
impression, which may then be kept up by smaller quantities frequently repeat- 
ed. The caincic acid is still more certain, and in smaller portions, care being 
taken not to give it when the stomach is stimulated by other medicines. Ad- 
ministered with these precautions, it is an efficient diuretic and purgative, and 
has already been employed with success in a considerable number of cases. In 
dropsy, it is asserted to be preferable to any other medicine hitherto discover- 
ed; not because it is more energetic, but because it is not attended with so much 
inconvenience. It is bitter and tonic, without being irritating; it acts gently 
and gradually, giving to the organs a mode of action opposed to that which con- 
stitutes the disease. It is difficult of solution in the stomach, and seems to act 
chiefly on the great intestine. Taken along with the food, it does not impede 
dig-estion. According to an analysis by M. de Saten, the constituent principles 
of the root of the cainca are emetine, caoutchouc, gallic acid, fecula, and a lit- 
tle wax. — Bev. Med. Jan. 1830, and Journ. Hehdom. 

34. One hundred and sixty grains of Camphor taken at a Dose. — A man, aged 
74, residing at Breslau, having' taken by mistake four ounces of camphorated 
spirits, which had been ordered as a liniment, soon became affected with the 
following symptoms: — burning heat of skin; frequent, full, and hard pulse; bril- 
liancy of the eyes; redness of the face; heavinessof the head; anxiety; agitation; 
violent sense of heat in the stomach — then intense head-ache, giddiness, indis- 
tinctness of sight, and ocular hallucinations. The patient only complained of 
the heat, which he said was intolerable. The camphorated spirits of the Prus- 
sian pharmacopoeia contains forty grains to the ounce, so that he had taken one 
hundred and sixty grains at once. Some spoonfuls of almond emulsion were 
given him at first, and the heat of stomach diminished after a few hours, but the 
symptoms continued. Two spoonfuls of a mixture, consisting of equal parts of 



Practice of Medicine. 237 

vinegar and thick mucilage. He was calmer during the night — his head was 
clearer, and the anxiety diminished; copious sweating came on, followed by- 
sleep, after which he became much better. The pulse, however, continued 
full and frequent, and the voiding of the urine difficult. A light infusion of di- 
gitalis, with acetate of potass, was now given, and under this treatment the pa- 
tient recovered in a few days. — London Medical and Surgical Journal^ Marcftj 
1830, from Rust's Magazine. 



PRACTICE OF MEDICINE. 

35. Tartar Emetic in large doses. — We learn from La Clinique for December 
last, that M. Laenstec, who was the first to employ tartar emetic in large doses, 
for the cure of articular rheumatism, abandoned this practice some time before 
his death, not having derived from it the advantages that he at first supposed 
he had. 

36. Otorrhea in Children. — Dr. Amelung states in a communication in 
Graefe and Walther's Journal^ B. XIL that he has employed with great suc- 
cess in this disease, especially when the discharge is foetid, an injection of a 
weak solution of corrosive sublimate. 

37. Oily Embrocations to the Mdomen as a Remedy for Ascites. — Dr. Zavaglt, 
an Italian physician, in a work he has published on this subject, relates many 
cases of ascites which were cured by oleaginous embrocations to the abdomen, 
after bleeding, squills, digitalis, calomel, and drastic purgatives had been ad- 
ministered without advantage. — Bull, des Sc. Med. July, 1829. 

38. On the Use of Stramonium in Mental Mienation, and some other diseases. 
— Dr. Amelung, in a communication in Huf eland's Journal for November, 1828, 
states that he has employed the stramonium in mental alienation, and some 
other diseases with surprising effect. He prescribes this medicine in the form 
of tincture which he prepares by digesting an ounce of the seeds in three ounces 
of alcohol. The dose for the deranged is ten or fifteen to twenty drops, two 
to four times a day; he has even given as much as thirty-six drops. In other 
diseases, the dose is one-half that required in cases of mania. A deranged per- 
son who will bear thirty drops four times a day, during the paroxysm, without 
any ill effects, experiences during his lucid interval from this dose, decided 
symptoms of poisoning. 

The cases of derangement in which this remedy is more particularly useful, 
according to Dr. A. are those of febrile mania, but it is contra-indicated when 
there is plethora, or a decided inflammatory diathesis. These must be first re- 
moved by bleeding, cold applications and affusions to the head, and by the in- 
ternal use of large doses of nitre, the tartar emetic, or digitahs. It is necessary 
in order to obtain a permanent effect from the stramonium, to continue its use for 
some time, and to augment gradually the dose. If vertigo and weakness of 
sight are produced, it is necessary to suspend its use, or better, to lessen the 
dose. 

In periodical mania. Dr. A. says that the stramonium is one of the most effi- 
cacious means to abridge the. attack and diminish its violence. Its prolonged 
use will also prevent a relapse. 

In obstinate epilepsy. Dr. A. asserts that the stramonium is the surest re- 
medy to shorten the paroxysms, and to lessen their frequency. He has never, 
however, effected a radical cure with it. He has also observed good effects 
from this remedy in some cases of convulsions, and of spasmodic cough, espe- 
cially after measles, in a case of catalepsy, and in cramps of the calf of the legs, 
to which pregnant women are oftentimes subject, especially at night. He has 

21* 



238 QUARTERLY PERISCOPE. 

also found it useful in ciironic rheumatism, as a palliative, but it will not effect 
a cure when the disease is inveterate. 

Dr. Hufeland in a note, states that the use of the stramonium requires g-reat 
caution; he says that it is one of the most active narcotics, and ten drops of the 
tincture of the seeds can produce very serious narcotism. — Bulletin des Sciences 
Medicaksy June^ 1829. 

39. On the Employment of Iodine in Lymphatic Tumours. — M. Batle has 
pubhshed in the Revue Medicale for March, 1829, twenty-five cases of white 
tumours, treated with iodine, some of them by himself, and the rest by other 
practitioners. In all these cases the patients were of a lymphatic constitution, 
and exhibited various symptoms of scrofula. Under the influence of the prepa- 
rations of iodine, the general health of all the patients improved, in a very remarka- 
ble manner, with one exception, a patient who was in articulo mortis, almost 
when placed under the use of the remedy. Of the twenty-five patients, twenty- 
four were affected with lymphatic tumours of the joints; one had only some 
lymphatic scabs, incontinence of urine during* the night, and some other scro- 
fulous symptoms. In eight the tumours were situated in the knee, six in the 
foot, three in the hip, two in the elbow; in the five others they occupied one or 
more articulations, and were accompanied with other symptoms of scrofula, as 
ophthalmia, albugo, discharges, &,c. The treatment consisted in the employ- 
ment of iodine in different forms. To all the tincture was given internally in 
various doses; some took only twenty-five drops daily, others one hundred. In 
eight of the cases the ointment of the tincture of iodine or ioduret of potash 
was used at the same time. Manson employed purgatives in most of the cases 
treated by him. The following are the results of the cases: — Cured fifteen, 
benefited six, not cured four — total twenty -five. The number of cases collect- 
ed by M. Bayle are not sufficient to determine positively the cases in which the 
iodine ought to succeed, or those in which it promises no advantage. The 
cases cured were those in which the tumours were neither very voluminous, 
nor open in many places, with atrophy of the limbs, or without general ema- 
ciation. A much greater number of facts are indeed necessary to establish po- 
sitively the principles of the treatment of these tumours by the preparations of 
iodine, and it is especially necessary that physicians should report their unsuc- 
cessful, as well as successful cases, otherwise we must be led to adopt too fa- 
vourable an opinion of the value of the remedy. 

40. Treatment of Hooping Cough. — Br. Kahleiss, who published in 1827, in 
Horn's Archives y a memoir on the efficacy of a mixture of belladonna, ipeca- 
cuanha, and sulphur in the treatment of pertussis, and who had employed it 
with the greatest success in one hundred cases of this disease, has inserted in 
Hufeland's Journal, for February, 1829, another memoir on this subject, in 
which he reports a great number of cases observed since, and which confirm 
his first results. The treatment of Dr. K. consists in the use of the following 
formulae. R. Pulv. rad. belladon. gr. iv.; pulv. Doveri, gr. x. ; lac. sulph. ^iv.,- 
sacchar. alb. pulv. ^ij. M. div. in chart xx. A child of two years to take one 
powder every three hours. Between each dose a tea-spoonful of the following 
to be given: — R. Aq. chamomile, ^j.; syrup, simp, ^ij.; acid, pruss. Vauque- 
lin, gtt. xij. The proportion of the articles in these prescriptions ought to be 
increased or diminished according to the age and temperament of the child. 
The author says that sometimes the effects of these remedies do not manifest 
themselves for five or six days; but then they become very evident, and gene- 
rally in from eight to twelve days at furthest the cure is complete. In some 
cases, after the employment of these remedies for two or three days a red ef- 
florescence of the skin appears, and a greater or less considerable dilatation of 
the pupils. In this case the treatment must be suspended for twenty-four or 
thirty-six hours, and the proportion of belladonna diminished.— ^rc^f res G^n^- 
ralesy Nov. 1829. 



Practice of Medicine. 239 

41. Partial. Paisy cured by Strychnia applied Locally. — Two cases of partial pa- 
ralysis have been successfully treated by Dr. Auchinci-oss with strychnia applied 
to the denuded cuticle. The first was a man ag-ed fifty-six, an habitual drunk- 
ard, admitted into the Glasg-ow Royal Infirmary on account of a varicose ulcer 
of the right leg. Ten days previously he suddenly lost the power of the left 
forearm and hand. The sensation of the parts remained perfect, but he was un- 
able to take hold of any thing, or to extend the wrist and finger joints. Had 
no head-ache. Being costive, his bowels were freely opened. A blister was 
then applied to the back of the forearm, and one-eighth of a grain of strychnia 
sprinkled over the vesicated surface. On each successive day the application 
was increased, by adding the original quantity to that of the preceding day, till 
it amounted to one grain, after which one-fourth of a grain, instead of one- 
eighth, was to be added. From the second week, he felt the parts to improve 
in power daily, with occasional sensation of prickling along the forearm and 
fingers. No obvious constitutional effect ensued. He was dismissed cured five 
weeks from the commencement of the treatment. 

In the case of another man admitted in August, with paralysis of flexor mus- 
cles, and diminished sensation of the right leg from knee downwards, a similar 
practice was pursued, with the same good effect. He was dismissed cured, 
having been under treatment during six weeks. 

At La Piti^ Dr. Bally is in the habit of treating cases of partial palsy in the 
above way, and is said to be very successful. In some cases he has made trial 
of the medicine internally without benefit. — Glasgow Medical Journal, May, 
1829. 

42. Treatment of Persons Poisoned by Hydrocyanic Acid. By M. Orfila. — In 
our last number we briefly noticed the treatment recommended by M. Orfila, 
in cases of poisoning with hydrocyanic acid, and now give further details from 
the Archives Generates, for July last. Neither liquid ammonia, oil of turpentine^ 
nor the infusion of coffee, administered even at the same time with the acid, 
seem to controul in the least degree its deleterious effects. Indeed science has 
not as yet discovered any substance capable of acting on this poison in the sto- 
mach, so as to destroy its baneful properties, and it is only by obviating the ef- 
fects produced on the system, that we can be of any service in these alarming 
eases. The most efficient means of this sort that we possess are, ammoniacal 
vapour, chlorine gas, affusions of cold water, and bleeding. 

Ammoniacal vapour. — Causing the person to inspire ammonia, diluted with 
twelve parts of water, is considered a good means of reviving the sunken powers 
of the nervous system, and will overcome in many instances the ill effects of 
this acid, if resorted to early; at the same time it might produce serious evils if 
it were employed undiluted, by inflaming the internal surface of the respiratory 
organ. M. Orfila made many experiments on dogs with this method, and found 
that when it was employed early, and the quantity of the acid was not so great as 
to kill in a very short time, it in many instances prevented the fatal effects where 
the poison would have inevitably destroyed hfe, had nothing been done; and in 
others, it prolonged the term of existence considerably. 

Chlorine vapour. — M. Orfila considers the inspiration of chlorine, diluted with 
four parts of water, a more efficacious means of obviating the poisonous effects 
of hydrocyanic acid, than either the ammoniacal gas or the cold affusions. By 
means of it he succeeded in recovering dogs that had taken a sufficient quan- 
tity of the acid to destroy them in fifteen or eighteen minutes, provided it was 
employed within four or five minutes after the ingestion of the poison. 

Affusions of cold ivater. — The affusion of cold water on the head, course of 
the spine, and even on other parts of the body, M. Orfila admits to be an excel- 
lent means to be employed in these cases. In eight experiments with this re- 
medy made on dogs, three were recovered that had taken sufficient acid to 
have killed them in a few minutes, and in the remaining five, life was greatly 
prolonged. 



240 QUARTERLY PERISCOPE. 

Bleeding. — M. Orfila believes that blood-letting may be useful in these cases 
by diminishing- the cerebral congestion, but that it is not a sufficient means of it- 
self to overcome the poisoning: at least he has never succeeded by copious 
bleedings alone in causing the untoward symptoms to disappear. 

Having thus examined successively the different remedies that have been of- 
fered tn obviate the poisonous effects of hydrocyanic acid, M. Orfila indicates 
in a few words the order of proceeding that it is proper to institute in these 
cases. First, to give immediately an emetic or purgative, if too long a time has 
not elapsed since the acid had been taken; but especially to be assiduous in the 
application to the nostrils of a flask containing the chlorine or ammonia diluted, 
desisting now and then to give the patient short intervals of repose. At the 
same time cold affusions to the head and spine are to be employed, bladders 
filled with ice to be placed on the head, blood to be taken from the arm or 
leeches applied behind the ears, and demulcent drinks given from time to time. 
By these means the evil effects will be usually averted, if too long a time has 
not elapsed since the ingestion of the poison. 

43. Sulphate of Sallcine a substitute for Quinine in the Treatment of Intermit' 
tent Fevers. — M. Devilliers communicated to the Royal Academy of Medicine, 
at their meeting, Dec. 1st, 1829, a letter from Dr. Gehakdin, in which the latter 
announces that he has substituted the sulphate of sahcine for the sulphate of qui- 
nine in the treatment of intermittent fevers, with success. Two cases related in 
this letter show the efi&cacy of this remedy extracted from the willow by M. 
Leroux, pharmaceutist at Vitry-le-Frangaise. Nearly two years ago, M. Buch- 
ner in Germany, and Dr. Rigatelli in Italy, obtained this substance, and employ- 
ed this remedy in intermittent fevers. — Archives Ginerales^ Bee. 1829. 

A case of intermittent fever successfully treated at the Hotel Dieu of Paris, 
by M. Bally, with the salicine, prepared by M. Leroux, is related in La Cli- 
nique, for January, 1830. 



OPHTHALMOLOGY. 

44. Intermittent Ophthalmia returning every seventh day. — This interesting 
case is related by Dr. Hueter of Marburgh in Graefe und Walther's Journal. 
C M. setat. 34, a labourer in a mill, subject to asthma, had, during the winter 
1826 and 1827, been frequently attacked with ophthalmia, first of the right, 
then of both eyes. This affection gradually subsided, but about three months 
afterwards, the right eye, in which the inflammation had been most violent, was 
on every Friday affected in the following manner. At two o'clock in the morn- 
ing, the patient was suddenly roused from bis sleep by a violent pain in the right 
eye, which at the same time became filled with tears, injected, and though it 
was not in the least swelled, caused a sensation of fulness as if it would burst,- 
lie could not bear the light, and felt as if there was sand between the conjunc- 
tiva and eye-lids. These symptoms continued during the whole day till the 
evening, when they subsided, with a great discharge of tears from both eyes. 
On the following day both eyes were perfectly well. During rainy weather, all 
the symptoms were much less violent than during bright sun-shine. The inter- 
mittent ophthalmia regularly continued till the spring of 1828, with this differ- 
ence only, that during the winter time, the attack began on Thursday night, 
and lasted only till Friday morning. On the 8th of April, 1828, the patient was, 
in consequence of a mechanical injury, affected with violent iritis of the left 
eye; it lasted for about seven weeks, during which time the right eye remained 
free from the attacks of intermittent ophthalmia. On Friday, the 23d of May, 
however, the latter returned, though not so violent as before. On the 27tli of 
May, the iritis of the left eye having then almost entirely subsided, a sensation 
of violent burning and itching suddenly arose in the left eye, with great pain 



Ophthalmology. 241 

©ver the eyebrow; these symptoms terminated in a great discharge of tears, af- 
ter which the eye was perfectly well. On the 30th of May the intermittent oph- 
thalmia again returned, but was much less violent than before; from this period 
the patient remained free from the affection, and up to the beginning of 1829, 
had, with the exception of one very slight attack of intermittent ophthalmia, 
been perfectly well. 

45. Amaurosis completely cured by the Extraction of a Carious Tooth. — Dr. Ga- 
I.ENZOWSKI, of Wilna, relates this case in Graefe und Walther's Journal. A 
man aged thirty-two, of vigorous constitution, but subject to rheumatism, was, in 
October, 1825, suddenly affected with violent shooting pain in the left upper 
jaw and eye, which continued for a few days, and then gradually subsided, but 
afterwards periodically returned. The patient did not take any notice of it un- 
til the pain became almost intolerable, and he observed that the sight of the 
left eye was completely gone. He applied to a medical practitioner, but find- 
ing no relief from his remedies, left the affection to itself About eight months 
after its commencement, a small tumour formed on the left cheek, and termi- 
nated in an abscess between the conjunctiva and lower eyelid of the affected 
eye; the quantity of purulent matter discharged from it amounted to several 
ounces. After this event the pain became much less; the blindness, however, 
continued, as before. The purulent discharge continued, and periodically in- 
creased, during about six months; after which time the pain in the eye became 
so violent as to induce the patient to apply to a practitioner at Wilna, with the 
determination of having the eye removed, rather than continue to suffer such 
excruciating pain. On examining the eye. Dr. Galenzowski found the pupil di- 
lated, and perfectly torpid, and sight so completely lost, that darkness and the 
brightest light could not be distinguished. There was no organic disease of the 
eye, the muscles of which appeared to act regularly; the purulent discharge 
continued; the pains in the eye were not so very violent as a few days before. 
On examining the mouth, a molar tooth was found to be carious to a great ex- 
tent, and moreover to contain in one of its roots a small piece of wood, by which 
a constant irritation appeared to have been kept up, which had eventually ter- 
minated in a perforation of the antrum, into which a probe could be made to 
pass from the cavity of the tooth. After the extraction of the latter, no dis- 
charge of matter ensued; but sight was restored in such a rapid manner, that 
the patient, after nine days' adequate treatment, by gargarisms, 8cc. was able 
to return to his native country. 

46. Cancer — Extirpation of the Eyeball. By John CourEit, M. D.. Surgeon to the 
Glasgow Royal Infirmary. — A man, aged 50, was admitted into the infirmary, 
February 9th, 1829, with a tumour at the outer canthus of the right eye, of a 
cartilaginous hardness, and adhering pretty firmly to the bony margin of the 
orbit. It is the seat of lancinating pain, which frequently shoots upwards along 
the forehead. In the centre of the tumour is an irregular ulcerated opening, 
which discharges a quantity of curdy pus. No denuded bone is felt with the 
probe. The integuments around the sore have a dull lived hue, and the eye- 
lids can be separated only to a small extent, showing a white, opaque, rough 
surface. 

The affection commxcnced five years ago, in the form of a pustule, at the 
outer angle of the eye, which broke, and formed a small irritable sore. This 
has slowly extended, so as to encroach on the eyeball, which has gradually 
shrunk. Vision of this eye has been lost for the last twelve months. General 
health good, with the exception of acidity of stomach. 

The tumour, the diseased portion of the eyelids, and the whole of the eye- 
ball, were extirpated. A strong hook being passed through the globe of the 
eye, its muscular and other attachments were divided with an ordinary small 
scalpel, excepting the optic nerve, which was cut with a pair of curved scissors. 
There was no bleeding, but the operation appeared to occasion most excruciate 



242 QUARTERLY PERISCOPE. 

Ing- pain, which did not abate till after the exhibition of a large anodyne. In 
four days, healthy pus was secreted, and at the end of a month he was dismiss- 
ed with the wound completely cicatrized. He has since shown himself, as di- 
rected, at the hospital several times, and continues in perfect health. — Glasgow 
MedicalJournaly Jlug. 1829. 

47. Pterygium cured hy Purgatives. — A man ag-ed twenty-nine, presented 
himself, November 27th, 1829, at the Chnique of Professor Rust, in Berlin. He 
complained of pain and lachrymation of his left eye; and on examination, the 
caruncle was observed to be very red, as were the free borders of both eye- 
lids; and from the external ang-le of the eye, there was a triangular red space, 
the base of which was at the angle, and the summit at the cornea. 

He ordered the patient a purgative of calomel and rhubarb, which was re- 
peated a number of times, and by the 2d of December, the pterygium had en- 
tirely disappeared. 

M. Rust disapproves of any operation at the commencement of pterygium, 
because, he says, the divided vessels always reunite, which produces a relapse. 
He disapproves particularly of the operation of passing a thread under the dis- 
eased part and excising it. He considers a derangement in the abdominal cir- 
culation as the most common cause of this disease; and that it is therefore ne- 
cessary to address remedies to the intestinal canal, with the double view of re- 
storing its functions, and of effecting a derivation. He uses as the only local 
application an astringent, and he considers Goulard's water the best. — La Cli- 
nique. Bee. 1820. 



SURGERY, 

48. Case of Carotid Aneurism in which the Artery was taken up above the 
Tumour. — In our last Number, we published a case in which the operation of 
Brasdor for the cure of aneurism was successfully performed by our distin- 
guished coadjutor Professor Mott: and we find from the January number of the 
Medico- Chirurgical Peview ihsit it has likewise been successfully achieved by 
A. Montgomery, Esq. surgeon in charge of the Civil Government Hospital at 
Mauritius. The subject of this latter case, a free black, aged about 30, tall, 
of spare habit, and rather given to intemperance, was admitted into the Hospi- 
tal, February 20th, 1829, with an aneurismal tumour the size of a pullet*s egg^ 
situated immediately above the sternal portion of the left clavicle, and so 
close to that bone, that it seemed to emerge from behind it, or rather from 
within the cavity of the chest; which rendered the taking up of the common 
carotid artery below the aneurism absolutely impracticable. 

The poor man had an almost constant tickling cough, with severe pain of the 
trachea; copious frothy mucous expectoration; great anxiety of countenance; 
hoarseness of voice; disturbed sleep; and was rather emaciated from constant 
watching. 

The account he gave of his case was, that he caught cold by sleeping ex- 
posed in the night air about a fortnight prior to his admission into hospital, at 
which period he first noticed the tumour. As there was considerable de- 
rangement of the digestive organs, the requisite cathartic medicines were 
given to restore their functions, and expectorants and anodynes for the cough 
and general irritation. 

21st. Has head-ache with severe fixed pain of the left temple; considerable 
fever; pulse 76, tense, and full, but irregular; the tumour increasing and 
pulsating strongly; has been three times copiously purged. V. S. ad ^x. mist, 
salinae simp. ^j. cum tart ant. gr. i, Stiis horis. Vespere. The bleeding pro- 
duced tendency to fainting, and has relieved the head-ache and fever, but 
the pain of temple and other symptoms continue. From this period the tu- 



Surgery. 243 

mour went on Increasing" rapidly until 9th of March, when it had acquired an 
alarming size, the base occupying" the space of two-thirds of the sternal por- 
tion of the clavicle, and ascending" nearly four inches upwards to the ang-le of 
the jaw, so that the volume of the tumour limited exceeding'ly the space for 
taking up the artery above it — the attempting of which I was induced to un- 
dertake from having read Mr. Wardrop's successful case in the 9th volume of 
the Lancet, folios 479 to 485. Seeing that no time was to be lost, as the tu- 
mour might soon burst, or the patient be suffocated by its pressure on the 
trachea, and that its rapidly increasing size would soon so far diminish the 
space for operating as to render an operation impossible, I requested a consul- 
tation of the principal medical officers of Port Louis, as well French as Enghsh, 
who all unanimously concurred with me in opinion that the taking up of the 
artery, ultra tumorem, was an adviseable measure. 1 immediately commenced 
the operation in the presence of numerous medical spectators, aided by my 
friends Dr. Ingham, Surgeon 29th Regiment, and Dr. Shanks, Assist. Surgeon, 
82nd Regiment, and Act. Chief of the Civil Medical Department. It may be 
observed here, that I was badly supplied with instruments, the want of which 
was however compensated by my able assistants. The operation was perform- 
ed in a similar manner to that described by Mr. Wardrop, and consisted in mak- 
ing an incision of an inch and a quarter long through the integuments and pla- 
tysma myoides muscle, by which the inner edge of the sterno cleido mastoi- 
deus was brought into view, greatly thrown inward and forward out of its 
natural position. This being drawn aside by a retractor, the incision was con- 
tinued on its inner side, in the direction of the carotid artery, with every possi- 
ble caution to avoid the superficial veins, one of which, of considerable size, 
crossed the neck, limiting very much my space for operating. The after part 
of the operation was attempted with a silver knife, as directed by Mr. War- 
drop, but finding that instrument too clumsy, and depending on the steadi- 
ness of my hand, I removed the cellular substance, and exposed the sheath of 
the vessels, by dissecting with the forceps and scalpel, occasionally using the 
handle of the latter, when I found it necessary. This dissection exposed the 
descendens noni running on the front of the sheath of the vessels, the bifurca- 
tion of the artery, the external jugular vein at the upper angle of the incision, 
and a vein the size of a large crow-quill crossing the artery at the lower angle, 
and immediately above the omo-hyoideus muscle, which limited the space for 
taking up the artery to little more than half an inch. The sheath of the vessel 
was now slit open, when the artery, vein, and par vagum nerve, were seen in 
their natural situations. 

The patient who had been very restless during the whole of the operation, 
suddenly raised himself up, so that I was compelled to seek again for tlie 
sheath, and being unable to find tlie first opening, I was obliged to make a 
second one. An attempt was now made to pass a rude, crooked aneurismal 
needle armed with a double ligature around the artery, in which I was foiled 
by the restless state of the patient. A second attempt proved more successful, 
as it passed with facility. On the ligature being laid hold of, the needle was 
withdrawn and on one ligature being secured the other was removed and the 
wound brought in contact by a simple suture and strap of adhesive plaster. 
The patient being now faint, a little wine and water was given and he was put 
to bed. It is remarkable that scarcely a drop of blood was lost during the 
operation, (which was performed in about 25 minutes,) except what escaped 
from the vessels of the integuments and platysma myoides, which did not ex- 
ceed a tea-spoonful. 

March 10th. The patient suffered very much from dyspnoea, cough, consi- 
derable and increased frothy mucous expectoration, and difficult deglutition for 
several hours after the operation, but which symptoms are now much abated. 
Pain of temple entirely gone; slept none in the night, for which he cannot ac- 
count? pulse 80, soft and full; tongue white, belly slow, the pulsation of tumour 



244 QUARTERLY PERISCOPE. 

less distinct, and he feels in every respect much relieved. 01. Ricini, ^j. Mist. 
Mucil. pro tusse. Vespere, well purged; Haust. Tinct. Opii, gtt. xxv. 

March 11th. Passed a tolerably good night; has less cough and irritation of 
the trachea; suffers but little from the wound, or tumour, in which there is 
still pulsation, but less distinct than prior to the operation; complains of fixed 
pain of left scapula; pulse at the wrist 88, soft, tolerably full and irregularly 
intermittent; skin natural; but little thirst. Mist. Salinas Simp. ^j. Tr. Digi- 
talis, gtt. viij. 3tiis horis. Potus Lemonade. Vespere, continues to go on 
well— pulse 72, no disposition to sleep. Haust. Tr. Opii, gtt- xxx. 

March 12th. Passed a good night; tumour much decreased in size; and says 
that the pulsation has entirely subsided, neither is it to be felt. Complains 
chiefly of slight difficulty of deglutition, (but less so than at any period subse- 
quent to the operation,) with a fulness at the epigastrium and flatulent eructa- 
tion. Voice more clear and distinct; pulse 78, soft and tolerably full, but still 
intermitting; no motion of bowels. Haust. cathart. ; continue mixture and 
potus. 

March 13th. Has had but one scanty stool; slept none until an anodyne was 
given at midnight, after which he slept well till five o'clock. Pulse 80, soft, 
tolerably full, and intermitting at longer intervals. The dressings being re- 
moved the wound presented no appearance of union. 

14th, The aneurismal tumour is reduced to one-half its original size, and 
does not pulsate when the patient is sitting up in bed. In the recumbent 
posture, however, an indistinct pulsation becomes perceptible. The patient 
is not sensible of any pulsatory movement in the tumour, but the wound has 
been painful and caused a restless night. Bitter tonic mixt. ^j. thrice a day; 
pil. hyd. gr. v. h. s. 

March 18th. Tumour continuing to decrease; distinct pulsation perceptible 
at a small point on the humoral edge of the aneurism, indicative of approaching 
2-upture of the sac. 

20th. Goes on well. In the evening slight haemorrhage from the wound, 
which, excepting where the ligature comes out, is entirely healed. Pulse 
much excited; general agitation and dread of approaching death. Pulsation 
at the point mentioned on 18th more distinct, but no where else over the tu- 
mour. Haust. ex tinct. digital, p. gtt. xx. Tt. camph. c. gtt. xl. 

21st. An indifferent night; no return of haemorrhage; pulsation at the point 
specified still distinct; pulse irregularly intermitting; belly confined. 01. ri- 
cini, ,^j. 

22d. Belly relieved; considerable return of hzemorrhage at half past 10 
o'clock last night, followed by chills and total cessation of pulsation at the 
point alluded to, but which has returned since 5 o'clock this morning; pulse 
irregularly intermitting. At 9 A. M. considerable bleeding from the wound; 
and at 2 and 4 P. M. bleeding recurred, but on every occasion was easily com- 
manded. 

23d. A good night; no renewal of haemorrhage; aneurismal tumour more 
distended, pulsating considerably; pulse irregularly intermitting; belly confin- 
ed. Pil. hyd. gr. v. h. s. 

March 28th. Aneurismal tumour again appears enlarged. 

March 29th. A small abscess had formed in the course of the cicatrix which 
discharged itself through the small opening left by the ligature, but by the 5th 
of April the discharge had ceased and the opening closed. 

May 28th. Since the last report the general symptoms have been unimpor- 
tant; the tumour gradually enlarged and threatened to suppurate, and the 
pointing prominence noticed on 18th March was so thin, as to cause apprehen- 
sion of its bursting momentarily. The next day (29th) it gave way, discharg- 
ing about eight ounces of fetid chocolate -coloured fluid. Compresses and 
bandage were applied to pre\"ent the apprehended haemorrhagy. On the 30th, 
these dressings, soaked with fetid discharge, were removed; there being no 



Surgery. 245 

sanguineous effusion, and perceiving the opening of the pointed tumour to be 
insufficient to give exit to the corrupted aneurismal blood, I ventured to en- 
large it. The incision being made, from' 6 to 8 ozs. of matter similar to the 
above, mixed with coagula, escaped. I introduced my finger and removed a 
considerable quantity of coagula and tenacious lymph. In the act of moving 
my finger for this purpose I felt the artery, below the seat of the ligature, 
without pulsation, the trachea pushed considerably to the right side, the ante- 
rior surface of the cervical vertebrae, and the muscles sterno-hyoideus and 
thyroideus as if dissected^ the sterno cleido mastoideus rounded, and as if 
knotty, admitting the finger to pass round it. After clearing out the sac a 
dossil of lint was introduced, and adhesive straps with bandage applied. 
These dressings being removed on the following day, the lint was found co- 
vered with pus, but no discharge from the wound, which looked tolerably well. 
The swelUng had very considerably subsided, the patient had passed a good 
night, breathed easier, coughed and expectorated less, and the pulse, from 
106, had fallen to 80. From this period the countenance and general condi- 
tion of the patient improved; and every day's visit gave additional reason to 
hope for his recovery. The great size of the tumour may in part be account- 
ed for by the decomposition of blood and disengagement of gas. The fetor of 
the matter was such, that I could not remove it from my fingers for two days. 
At the present period, (8th June,) the patient begins to walk out of doors, 
there is no discharge from the wound, which is on the eve of healing; all tu- 
mour has entirely disappeared from the neck, and whatsoever fate be in re- 
serve for the patient, the aneurism at least seems to be cured. 

49. Treatment of Aneurisms by the Method of Valsalva. — It is stated by M. 
Paiilaud, in the Mevue MHicale for January, 1829, that M. Dupuytren, who 
has often seen aneurisms treated by the method of Valsalva, has frequently ob- 
served that under this treatment aneurismal tumours of the chest, abdomen, 
and limbs, augment in volume, instead of diminishing, and finally rupture. 
M. D. explains this phenomena by supposing that the bleeding weakens the 
parietes of the arteries more than it does the power of the heart, and the latter 
having thus a greater relative force, ruptures the former. 

50. Gastrotomy successfully performed. By Dr. Catroche. — A woman aged 24, " 
to excite vomiting, introduced a fork into her throat, and permitting it to slip 
from her fingers; it descended into her stomach, where it remained for many 
months without producing any apparent injury; but finally very violent effects 
which threatened the life of the patient supervened, and Dr. Cayroche, after 
consulting Professors Delpech and Pages, performed gastrotomy; the fork was 
easily extracted, and at the end of about twenty days the wound was healed. 

We take the above notice from the Revue Medicate for March, 1829, and re- 
gret that more details are not furnished. The case was reported to the Medi- 
cal Society of Bordeaux, by Dr. Barres. 

51. Prolapsus Ani treated according to the Method of Mr. Hey. By Dr. 
Macfarlane. — A shoemaker aged 54, became a district patient in the begin- 
ing of February. The gut descended for more than two inches on every at- 
tempt to evacuate the bowels, accompanied with considerable pain and te- 
nesmus. When he remained for a few minutes in an erect position, the same 
displacement took place slowly, although no propulsive efforts were em- 
ployed; this, however, could be prevented by pressure. The first thing pro- 
jected from the anus was a circular fold of the mucous membrane of the rec- 
tum, at its verge, of a livid colour and tuberculated appearance, and this was 
soon followed by the complete descent of the bowel and haemorrhage from in- 
numerable points. The recumbent posture and gentle but continued pressure 
for a few minutes generally effected the reduction of the prolapsus, although 
at an earher period it often continued irreducible for hours. His general 

No. XL— May, 1830. 22 



246 QUARTERLY PERISCOPE. 

health was much Impaired, and the constant irritation and almost daily attacks 
of haemorrhag-e, disabled him from following- his employment. 

*' On examining the anus after the g-ut was replaced, the surrounding in- 
teg-uments were found extremely relaxed. There existed such an unnatural 
looseness in the attachment of the skin around the anus, to its corresponding 
cellular membrane, that it could be easily drawn out with the fingers in the 
form of one or more large flaps. Having succeeded in two similar cases, 
which came under my care in the Royal Infirmary, during the summer of 1826, 
in completely curing the disease, by cutting off the loose integuments, as 
recommended by the late Mr. Hey, I determined to try it in this case. The 
skin was drawn as far out as possible into broad flaps, and cut off with the 
scissors in a circular direction, until all the superfluous integument was re- 
moved, including a portion of the livid and tuberculated fold of mucous mem- 
brane, which was projected from within the sphincter. The pain was trifling, 
and only a few drops of blood were lost. A soft compress and T bandage 
were applied, and he was strictly confined to bed. For a few days, a partial 
procidentia took place on every attempt to go to stool. He had a good deal 
of pain and inflammation around the anus, attended with complete retention of 
urine, which required the frequent introduction of the catheter. In ten days . 
after the operation, he was able to walk about, and void his stools, without any 
return of the disease, and in three weeks he was perfectly cured. Pressure 
was continued to the part for some time longer — occasional doses of castor oil 
were prescribed, and he was enjoined to avoid straining at stool. 

♦'There will generally be found in obstinate and long-continued forms of 
this disease, a great relaxation in the connexion of the rectum at its lower 
part, with the surrounding textures. This circumstance, although it may not 
be the original cause, is sufficient, in many cases, to account for the continu- 
ance of the displacement in chronic and inveterate cases, although 1 believe it 
is generally accompanied by a diminished power of the sphincter. If the 
rectum, in consequence of being much irritated, as in various bowel com- 
plaints, ultimately becomes relaxed, the tenesmus, which is an invariable at- 
tendant, may so overcome the sphincter, as to give rise to a procidentia. But 
when, as in the case now detailed, the erect position is sufficient to cause a 
descent of the gut, we have grounds for believing, that besides the relaxed 
state of the rectum, there exists a want of power in the sphincter muscle, 
which part, along with the levator ani, is mainly instrumental in maintaining 
the rectum in its natui'al situation. In the cases detailed by Mr. Hey, there 
existed in combination with relaxation of the integuments, one or more livid 
tubercles at the verge of the anus, which were also removed. He expected 
from this operation, that inflammation of the surrounding cellular texture would 
be excited, the attachments of the rectum consolidated, and the power of the 
sphincter improved. In a majority of cases, the disease will be found to yield, 
(although the cure is often tedious and protracted,) to the local applications 
and internal remedies usually employed. Should it continue, however, as 
sometimes happens after the exciting cause has been removed, we w411 occa- 
sionally find that the loose state of the skin around the anus, and the relaxed 
attachments of the rectum, at its termination, become the primary causes of 
the continuance of the disease. It is, I conceive, in such circumstances that 
this simple operation may be beneficially adopted."— G/a^g-oto Med. Journal, 
Nov. 1829. 

52. Treatment of Strangulated Hernia when the part is Gangrenous. — M. Dw- 
PUTTREX says that in strangulated hernia, when the included part is gangre- 
nous, the stricture should not be divided, that operation being in this case use- 
less and dangerous. The only indication is to make early free incisions to ex- 
pose the gangrenous parts, to facilitate the evacuation of the faecal matters, and 
to prevent their infiltration without the sac. If the gangrene have made but lit- 
tle progress, and the discharge of faecal matters be difficult, a female catheter 
or gum elastic sound, should be introduced into the superior portion of intesdne 



Surgery. 247 

and allowed to remain until a free passage for the faeces is established, when it 
is to be withdrawn. If the surgeon has doubts of the exact condition of the in- 
testine, M. D. says he should not fear to incise the intestine, as if it were spha- 
celated, since it is shown by a great number of cases, that an opening of the in- 
testine without loss of substance, neither aggravates the disease, nor retards the 
cure, in the greater number of cases. General and local bleeding, diluent drinks, 
and diet, ought to be employed to relieve the inflammation of the abdominal 
viscera. — Revue Mddicale, Nov. 1829. 

53. Naevus Maternus Cured hy Vaccination. — The following case is related by 
Dr. AvcHijfCLoss, in the Glasgow Medical Journal, for May, 1829. A girl, aged 
eight months, was brought to the Glasgow Royal Infirmary, in September, 
''having a naevus on the lower part of the forehead, half an inch above the left 
inner canthus. It was as large as a hazlenut, and of a dark red colour. It was 
observed at birth, and was then quite level with the surface. After a month it 
became elevated. Having never been vaccinated, fresh lymph Vi- as inserted by 
minute punctures, both around the circumference and over the whole extent of 
the tumour. On the eighth day many small pustules were visible, and by the 
twelfth they had coalesced, and become incrusted. On the twenty-first, the 
scab separated, leaving the surface underneath tender and shghtly prominent. 
A second crust succeeded, and to this a third and a fourth; a perfect cure being 
eifected in about six weeks. 

'*I perfectly agree with those who have made trial of this practice, that it is 
indispensable to the ultimate success of the case, that the lymph should be freely 
introduced over the diseased surface, as well as around its circumference. In 
this way, the adhesive inflammation which is excited, appears to extend from 
one pustule to another, and in the course of a few days the whole becomes in- 
volved in one scab. 

54. Extirpation of the Uterus. — This operation has been performed many 
times in Germany, in patients affected with prolapsus or inversion of the ute- 
rus. Dr. Wolff', of Cellein Hanover, removed not only the uterus, but after- 
wards the ovaries: the patient died. 

Extirpation of the neck of the uterus has been performed by Osiander twenty 
three times, by Lisfranc thirty-six times, several times in England, and twice 
in this country, once by Dr. Warren and once by Dr. Strachan; in Dr. Warren's 
case part of the body of the uterus was also removed. 

Extirpation of the whole uterus for cancer, this organ being in its normal 
position, has been performed, so far as we can learn from published accounts, 
ten times, and it is a matter of great interest to ascertain how far the results of 
these cases justify a resort to an operation, certainly the most serious and pain- 
ful in surgery. This operation was first performed by a German surgeon, Dr. 
Sauter, of Constance, in January, 1822. By the commencement of April, his 
patient's health appeared restored, except an incontinence of urine arising from 
an opening of the posterior portion of the bladder; she died, however, on the 
Ist of June, apparently of another disease. On examination, no trace of can- 
cer could be discovered in any of the organs. In Great Britain this operation 
has been performed six times, four times by Mr. Blundell,* once by Mr. Ban- 
ner,! ^"^ once, by Mr. Lizars. Of Mr. Blundel's cases only one survived the 
eflPects of the operation, and she died about a year after, and on examination 
the upper end of the vagina was found uneven, partially ulcerated, vascular, 
and connected with a mass of cerebriform matter; the ovaries, back part of the 
bladder, the lumbar glands, and upper part of the rectum also were all affect- 
ed with organic disease, t Mr. Banner's patient died on the fourth day, and the 
result of Mr. Lizars' case has not been published. In France the operation has 
been performed three times, once by M. Recamier,§ and twice by M. Roux, the 

• Lond. Med. Gaz. Vol. II. p. 294. t Idem, p. 582. X Idem, Vol. III. p. 800. § See our last No. 



248 QUARTERLY PERISCOPE. 

two latter operations were fatal. Thus of ten operations, or rather nine, (fo? 
the result of Mr. Lizars' not being- known, it should not be counted,) three only 
are claimed as successful. Of these successful cases, M. Sauter's, died five 
months after the operation; Mr. Blundell's died one year after the operation, 
and certainly ought not to be considered successful, since, thoug-h successful as 
regards the extirpation, it was unavailing- in respect to the preservation of life; 
M. Recamier's case has been only recently performed, and the result is still to 
be ascertained. Such are the facts in relation to this operation, and are thus 
certainly far from encouraging-, on the contrary, they appear to justify the fol- 
lowing remarks of the editor of the Medico-Chirurgical Review. " We consi- 
der the extirpation of the uterus, not previously protruded or inverted, one of 
the most cruel and unfeasible operations that ever was projected or executed 
by the head or hand of man. We are very far from discouraging bold or un- 
tried operations, but there is a line beyond which it may not be prudent to go, 
even should a solitary instance or two of success rise up as precedents to bear 
out the operator." In our esteemed coteraporary, the Journal Generale de Me- 
decine, the learned editor. Dr. Gendrin, has given a sketch of all the operations 
for extirpation of cancerous uteri that have been made public, and to that work 
for October last we refer the reader who desires further details. 

Since the above was written, we have received the number of La Clinique 
for the 20th of January last, from which we learn that M. Recamier again per- 
formed this operation, on the 13th of January, and that haemorrhage supervened, 
and the patient died the second day after the operation. 

55. Case of Strangulated Crural Hernia, reduced spontaneously after Gangrene 
of the Hernial Sac.' — This singular case was communicated to the Medical So- 
ciety of Paris, by Dr. Girouard, of Sancheville, and is published in the Journal 
Gdn^rak, for December last. March 18th, 1826, Dr. S. was called to a woman, 
aged thirty-one years, in the sixth month of her pregnancy, who had been 
affected for four years with a crural hernia of the right side. This hernia, or- 
dinarily indolent, entirely reducible, and of the size of a pullet's egg, had ac- 
quired suddenly the size of a fist, in consequence of an effort the preceding day 
to repress a fart. The patient was affected with the usual symptoms of stran- 
gulated hernia, and tonics, bleedings, baths, leeches, emollient cataplasms, to- 
bacco injections, &c. employed without success, and an operation proposed, 
but the patient refused to submit to it. On the sixth day the hernial tumour 
became livid, clammy, and the epidermis raised, forming here and there phlyc- 
tenx filled with a reddish seroslty. During the night, violent colics; the patient 
was sensible of something quitting the tumour and enter the abdomen; after 
this copious evacuations from the bowels took place. The seventh day the mor- 
tification of the envelopes of the hernia became evident, and all the symptoms 
of strangulation had disappeared. The fifteenth day the mortified parts were 
thrown off, and comprised not only the skin and peritoneal envelope, but also 
the periphery of the crural opening, so that the fingers together could be in- 
troduced into this opening; behind this opening a portion of intestine, highly 
injected, and which completely closed it, was perceived. The opening healed 
by granulations by the fortieth day, and at the full period of utero-gestation 
the patient was delivered of a healthy child. 

56. Fissure of the Jnus successfully treated without Incision or Cauterization. 
By M. DupuYTREN. — M. Dupuytren considers spasmodic constriction of the 
sphincter as the true lesion in this affection, and the elongated ulcer called 
fissure of the anus as a secondary phenomenon. In curing the stricture of the 
sphincter the disease is cured, and the anti-contractile property of the bella- 
donna renders it a proper application. M. D. has effected cures with this re- 
medy a number of times. The following case is reported in the Revue Me^ 
dicale, for March, 1829, by M. Palllard. A healthy young woman had been 
affected for some weeks with very violent pains in the anus, whenever she went 



I 



Surgery. ' 249 

to stool, especially when the faeces were hard. At first these pains continued only 
a few minutes, but afterwards they persisted longer, and finally continued dur- 
ing some hours. When she entered the Hotel Dieu her anus was examined 
with care by M. Dupuytren, who discovered there a very superficial fissure. 
The constriction of the anus was very considerable, the finger could not be in- 
troduced into it without difficulty and causing" great pain. Unwilling to sub- 
ject the patient to the pain and inconvenience of an incision or cauterization, 
M. D. prescribed the introduction into the anus of a roll of lint smeared with 
the following ointment, and renewed every time the patient went to stool: }J. 
Axunge, ^vi. ; extr. bell, ^j.; acet. plomb. ^i. M. This ointment calmed the 
pains; in a few days they entirely ceased, and the patient was relieved of her 
disease. 

57. Amputation of the Penis. — When the penis is excised, especially near the 
pubis, from the retraction of the parts it is sometimes difficult and even impos- 
sible to discover the opening of the urethra, so as to introduce a catheter into 
it, whence very unpleasant or even fatal results may happen. To obviate this 
difficulty, some operators introduce into the urethra a metallic sound, upon 
which they cut; this renders the operation, however, longer and of course sub- 
jects the patient to more pain. M. Barthelemy, Surgeon to the Hospital du 
Gros-Caillon, recommends the introduction of a gum elastic catheter as far as 
possible into the bladder, when the penis and catheter are both to be divided 

' by a single cut. — Journal Universely August ^ 1829. 

58. Dupuytren' s Method of Removing Fibrous Polypi of the Uterus. — M. Du- 
puytren, instead of the metliod hitherto emplo3'ed for the removal of uterine 
polypi, extirpates them in all cases with the knife. He has been led to prefer 
this operation, from tlie consideration of the fibrous nature of polypi, the faci- 
lity with which by moderate but continued traction the uterus may be drawn 
even with the vulva, the fact that haemorrhage is less to be feared than is sup- 
posed, and that the difficulties arising from the deep situation of the pedicle of 
the tumour may be easily overcome. Besides, it is sometimes impossible to ap- 
ply a ligature, either because the tumour is too deeply situated or completely 
fills the vagina, and even greatly distends it, so that the fingers or instrument 
for applying the ligature cannot be introduced; moreover the consequences of 
the application of the ligature are often very dangerous. The following is M. 
Dupuytren's mode of operating. The patient is placed on her back upon the 
edge of a bed, her legs and thighs flexed and fixed as for the operation of litho- 
tomy. Very strong dressing forceps are introduced into the vagina, with which 
the polypus is seized hold of, if it do not project beyond the vulva; the forceps 
are introduced on the finger or with the aid of a speculum; in this last case their 
branches must be straight and the rings small, so that they can pass into the 
speculum, when the latter is withdrawn from the vagina, after the polypus has 
been seized hold of by the forceps. The surgeon then employs gradual trac- 
tion to draw out the polypus, or if it already project beyond the vagina, to ex- 
pose its pedicle. Sometimes a single forceps is not sufficient, the first is then 
confided to an assistant, who continues the tractions, and the surgeon takes 
hold of another part of the polypus with another pair of forceps, and thus the 
desired effectis produced. Thepedicle being broughtto the orifice of the vagina, 
the surgeon ascertains the size of the pedicle and whether there be in it any 
Isirge arteries, the latter is ascertained by the pulsation. If there be pulsations, 
a ligature is to be applied above the place where it is intended to make the 
incision, but where no pulsations are discovered, the pedicle is to be divided 
with a bistoury or scissors curved on both sides. When there is no pedicle, M. 
Dupuytren makes around the anterior half of the base of the tumour an inci- 
sion which penetrates into the mucous tissue, the sub-mucous cellular tissue, 
or even the proper tissue of the uterus; a similar incision is made posteriorly, 

22* 



250 QUARTERLY PERISCOPE. 

the two Incisions united, and the tumour dissected out. In this case the opera-' 
tion is more comphcated, and may be more readily followed by haemorrhage, 
inflammation, &c. M. Paillard, who reports this method in the Revue Medicale for 
June, 1829, states that numerous successful cases attest the advantages of this 
operation. It may be conceived that when these tumours are soft or have de- 
generated so as to tear easily, that it will present obstacles to the operation, but 
with patience, prudence, and slow and moderate traction, M. P. says that the 
surgeon will eventually succeed. Experience proves, he says, that dangerous 
hemorrhage never occurs; once only M. D. has been obliged to have recourse 
to the tampon, which readily arrested the haemorrhage. 

59. Treatment of Indolent Ulcer of the Leg. — J. Stme, Esq. of Edinburgh, has 
lately adopted a method of treatment of indolent ulcer of the leg, certainly one of 
the most perplexing affections that the surgeon is called upon to treat, which he 
considers as in many respects preferable to the method recommended by Mr. 
Baynton, though he believes that the latter when properly executed will sooner 
or later effect a cure, if a cure be practicable. "Some frivolous and wrong- 
headed improvers have advised," says Mr. S. "that the straps should not encir- 
cle the whole limb, but only two-thirds of it, and hence have done what they 
could to bring themselves and the practice into contempt. I have lately cured 
an ulcer on the leg of a lady, which had existed without interruption for twenty 
years, and was deemed incurable, because it had resisted the most assiduous ex- 
ertions of several surgeons in town. When I proposed to apply adhesive plasters, 
the patient would hardly consent, because they had been tried previously with- 
out success. I asoertained that they had not encircled the limb, and hence the 
failure." 

Mr. Syme's method, which he prefers to Baynton's, consists In the applica- 
tion of a blister over the ulcer. " It is not unusual to meet with cases of indo- 
lent ulcers," he observes, " which after exhibiting their characteristic obstinacy 
in opposition to the most careful treatment, heal up at once without any atten- 
tion, so soon as the limb begins to recover from an attack of phlegmonous ery- 
sipelas which it has happened to suffer. The observation of such cases led me 
to try the efftxt of inducing a similar inflammation artificially, and the result has 
fully equalled my expectations. The means employed for this purpose were 
bhsters, and the object being to excite a smart and diffuse inflammation, they 
were not limited in extent to the size of the sore, but were made to cover a 
great part of the limb, and were allowed to remain in operation for a long while, 
sometimes even twenty-four hours. 

•* The first effect of the blisters in these cases Is a more than ordinary inflam- 
mation and discharge, the surface sometimes continuing to suppurate profusely 
for several days, just as if the cutis had been denuded by a scald or burn. 

"In a day or two the patient is agreeably surprised by observing that the oede- 
raatous swelling of the limb, which so constantly accompanies ulcers of the 
kind under consideration, begins to subside, and in the course of a very short 
time, rarely exceeding a week or two, it nearly or entirely disappears. The con- 
sequence of this detumescence is a great diminution in the size of the sore, 
which also comes to be on a level with the surrounding skin. Then the sur- 
face takes on a healthy granulating appearance, and the sore heals, partly by 
contraction, partly by the formation of a cicatrix. For the first few days after 
the blister has been applied, some simple ointment may be used, just as in the 
ordinary treatment of a blistered surface, and afterwards a wash of acetate of 
lead, or sulphate of zinc, in the proportion of one or two grains to the ounce. 
If the sore should again prove obstinate, the blister may be repeated, and if a 
small part remains stationary towards the conclusion of the cure, it ought to be 
filled with the red oxide of mercury, or a mixture of this powder with flour. 
My friend. Professor Davidson of Aberdeen, induced me to try this application 
in the treatment of ulcers, and I cannot say too much in its praise, especially 



Surgery. 251 

in the case just mentioned. After one or two dressings it forms a firm crust 
over the sore, which ought not to be disturbed, and renders any further inter- 
ference unnecessary." 

Mr. S. ascribes the good effects of blisters which have been just described, 
to their stimulating the absorbent vessels, so as to remove the oedema. 

This treatment cannot be considered as new in this country, the late Dr.Dor- 
sey, many years ago, recommended and successfully employed powdered can- 
tharides as an application to certain indolent ulcers of the leg. See his Elements 
of Surgery. — Edin. Med. and Surg. Journ.Jan. 1830, 

60. On Operations Performed at the Solicitation of the Patient, against the 
Judgment of the Surgeon. — We find in the Bevue Medicate, for March, 1829, the 
following interesting- observations on this subject, by M. Paillard; they may 
be considered as expressive of the sentiments of M. Dupuytren. It is gene- 
rally observed that severe operations, performed against the opinion of the sur- 
geon, merely to comply with the desires of the patient, are rarely successful. 
Whatever precautions are taken to insure success, death often supervenes. 
Although the surgeon explains to the patient all the hazards of the opera- 
tion, and consequently has nothing to reproach him-self with, still the idea of 
having been the cause of the death of an unfortunate person, must painfully 
afflict him. The case we are about to relate, is calculated to render surgeons 
exceedingly circumspect, and induce them to refuse with firmness to perform 
operations merely to satisfy the patient. M. Dupuytren has seen the most vio- 
lent symptoms supervene in consequence of the amputation of a deformed great 
toe. In another instance, death followed the extirpation of a supernumary fin- 
ger in an adult. A case is related of amputation of a badly-formed leg, by M. Du- 
puytren, which terminated fatally, and the same result took place in a case of 
a similar kind, operated upon by Sabatier. 

The following case was communicated to Dr. Paillard by Dr. Sterlin. An 
old servant had been affected for some time with an ulcer of the leg which 
would not cicatrize permanently; tired with being constantly obliged to at- 
tend to a disease that returned continually, he entered the Hotel Dieu, of 
which Pelletan was then first surgeon, and earnestly solicited him to perform 
amputation. M. Pelletan at first refused, but finally yielded to the solicitations 
of the patient, and consented to operate, not however without previously ex- 
plaining to him all the hazards he encountered; but the patient was inflexible. 
The first few days every thing seemed to promise a favourable termination, but 
quickly violent symptoms supervened, some important viscera became vio- 
lently inflamed, and the patient was soon in the utmost danger. Just before his 
death he collected his strength, and in an energetic manner, and with an elo- 
quence that would not be suspected in an uneducated man, he reproached M. 
Pelletan for his weakness in yielding to his solicitation. He died some moments 
after having thus given vent to his anger. M. Pelletan was of course very 
much aflfected by this painful scene, and long preserved the remembrance of it. 

61. Case in which a Portion of Bone was lodged for Forty-eight Days in the 
Trachea of an Infant. — This singular case is related by Thomas Stabb, Esq. in 
the London Medical Gazette for December last. "On the 20th of September 
last, S. H. S. aged ten months, playing with a bone of a neck of mutton, which 
the nurse gave her whilst at dinner, put it into her mouth and detached a small 
portion, about the size of a large marrow-fat pea, which slipped into her wind- 
pipe, and produced violent coughing and irritation for about five minutes, when 
it ceased, leaving a noise in breathing like that produced by a saw. In the 
course of twenty-four hours great difficulty of breathing, with constitutional 
irritation and cough, came on, which was subdued by the usual remedies. The 
same saw -like noise of breathing and some cough continued, but did not appear 
to give pain after the fourth day; the child's health and spirits after that time 
appearing as good as usual, except this constant wheezing. 



252 QUARTERLY PERISCOPE. 

" On the 3d of November, upwards of six weeks after the accident, in conse- 
quence of a cold she took from g'oing- out into the air, violent irritation in the 
trachea, with coug-h, returned. A solution of tartarized antimony was given", 
and on the 7th, after a dose which produced vomiting- and g-^neral relaxation, 
and whilst the nurse was briskly rubbing" her throat with a volatile embrocation, 
the head being bent back over her lap, she was seized with a violent fit of 
coughing, and threw up the piece of bone, imbedded in mucus, which had been 
retained forty-eight days in the trachea; her breathing almost immediately be- 
came natural, and the next day she was as well as ever. The piece of bone was 
very rough, of a triangular shape, the edges quite sharp." 

62. Wax as an Appllcaiion to Ulcers. — The application of wax to old ulcerated 
legs has been practised in the Westminster Hospital, with great success, within 
the last few months. In every instance it has rapidly improved the character 
of the sore, and brought on a disposition to skin over, and in the greater num- 
ber of cases the ulcers have healed in a much shorter time than could have 
been calculated with the ordinary applications — indeed it has succeeded often 
when all the usual dressings had been tried and failed. — Ibid. 

63 . On the Utility of Water as an Application in the Treatment of Wounds, 
Ulcers, Diseases of the Skin, &c. By JoHJf M'Fabzen, M. D. Surgeon, Butte- 
vant. — The treatment of ulcers, wounds, &c. by the simple application of wa- 
ter, was revived some years since by Professor Macartney, of Dublin, and it has 
been said with great success; and in the Edinburgh Medical and SurgicalJour- 
nal, for January last, Dr. M'Fadzen has published some observations and cases 
illustrative of its efficacy. The mode of applying this remedy is exceedingly 
simple and attended with very little trouble. "A piece of lint dipped in cold 
water is to be applied with the soft side to the part, and covered with oiled 
silk, which sholild extend considerably beyond the limits of the lint, and re- 
tained in its place by a light bandage, or any other means the practitioner may 
deem proper. Any other substance capable of preventing evaporation, and 
sufficiently light and pliable, such as very thin Indian rubber, would answer 
the purpose as well as oiled silk. The dressings shouldberemoved three times 
a-day, or less frequently, if the secretions from the part are trifling, for the pur- 
pose of wetting the lint as it becomes dry, and freeing it from the secretions of 
the wound or skin, which would in a short time become irritant; therefore it is 
not sufficient that the lint should be merely moist, for this moisture may be oc- 
casioned by perspiration or other discharge of the part collected under an im-. 
pervious substance. Hence the lint must either be occasionally removed, or 
well washed in cold water, and in like manner the oiled silk or Indian rubber. 

"From what has been stated, it must appear that the good effects of this 
treatment depend upon the production of steam at the temperature of the 
surface of the body, which, being retained by the impervious silk, subjects the 
part constantly to an atmosphere of that vapour. 

"I hope it may not be considered irrelevant to mention here, that oiled silk 
is also a valuable substance for applying the emollient poultice, having this ad- 
vantage over linen or calico, that it retains its moisture and heat, at least the 
heat of the surface over which it is placed, for a greater length of time." 

64. Tinea Capitis. — There are perhaps few practitioners who have not been 
occasionally foiled in their attempts to cure this disease. The stimulating oint- 
ments and applications usually recommended, we havefound very frequently to 
fail in affording relief, and notunfrequently they aggravate the mischief. We have 
been most successful with the physiological practice — treating the disease 
like other inflammations, with leeches, and then applying a poultice of flax- 
seed mucilage to the scalp, covering it with an oil-silk cap. After all in- 
flammation has been subdued by these means, a moderately stimulating oint- 
ment may sometimes be found useful. In the last number of the Edinburgh 



Surgery. 253 

Medical and Surgical Journal, Dr. M'Fadzen recommends a lotion of the acetate 
of lead, which Dr. Macartney also says will cure the eruption. The only thing 
to be feared, says Dr. M'F. is its being- healed too suddenly. The following 
case, in which the remedy was successfully employed, is given. A boy, aged 
eleven, of a flabby habit, and subject to a cough, has been labouring for some 
years under Tinea capitis, or the Porrigo scutulata of Dr. Bateman, which has 
resisted all the common remedies, both local and constitutional, not only under 
my own care, but by the advice of others. The head having been shaved and 
well washed with soap and water, which exposed a number of inflamed irrita- 
ble patches, covering about half of the hairy scalp, 1 dressed the head accord- 
ing to Professor Macartney's plan, namely, covering the diseased scalp with 
charpie dipped in a solution of the acetate of lead, (gr. iij. ad ^i. Aq.) and ap- 
plying over all a well-fitted oiled silk cap, leaving directions to wash the lint 
three times a day in cold water, in order to free it from the secretions of the 
skin, reapplying it to the head, wetted with the medicated lotion. He has call- 
ed upon me this day, (July 26th,) when I was happy to find him nearly cured, 
the inflamed and irritable patches having been replaced by a comparatively 
healthy skin. No constitutional treatment whatever was resorted to. 

65. Case of Fracture and Depression of the Inner Table of the Cranium ly a 
musket ball, the External Table being uninjured. — The following singular and 
interesting case, which occurred in the practice of StaflT-surgeon Cooper, is re- 
lated by Dr. HE^ivrEN- in his Military Surgery. The patient was struck at the 
battle of Waterloo, with a musket ball, on the right parietal bone, which was 
exposed, and had no appearance of being fractured; as, however, the symptoms 
of compression were urgent, and the patient was nearly in a lifeless state, Mr. 
Cooper conceived it right to apply tiie trephine to the part on which the vio- 
lence had acted. He had not sawn long before the external table came away 
in the hollow of the trephine, leaving the inner table behind, which was not only 
splintered, but driven at one point more than half an inch into the membranes 
and substance of the brain. No sooner were the fragments taken out with a 
pair of forceps, than the man instantly sat up in his bed, looked around, and 
began to speak with the utmost rationality. It is a most extraordinary fact, that 
this patient got up and dressed himself the same day, without leave from the 
medical oflficers, and never had a bad symptom afterwards. 

66. Dislocation of the Clavicle forwards. — Reduction at the Expiration of 
Twelve Weeks. — A man aged 50, fell with his arm outstretched in such a man- 
ner that it bore the whole brunt of the violence. Inability to raise the arm as 
before, and "an intense dull swelling, which after a time became almost imper- 
ceptible from the enormous degree of tumefaction which ensued," were the 
consequences of the accident. No attempt at reduction was made, and twelve 
w^eeks after the occurrence of the accident he entered the Winchester Hospi- 
tal under the care of Mr. Lyford. On the superior part of the sternum was a 
distinct obtuse projection, exquisitely sensible when touched, and attended 
with shght inflammation of the integuments; this projection could readily be 
traced as a continuation and termination of the clavicle, though the motions of 
the shoulder appeared to produce no alteration in its situation. The motions 
in question were painful; the shoulder itself had a decided inclination forwards, 
and the distance between its point and the mesial line of the sternum, was 
shorter, on admeasurement, than in the opposite extremity. 

** The treatment consisted in the application of the clavicle bandage with 
pads under the axilla. The shoulders were drawn backwards, as far as they 
could be, which was not, however, to the fullest extent, the patient having ac- 
quired, from his agricultural pursuits, a somewhat prominent back, so that the 
bases of the scapulae were farther asunder than natural. The efi^ect of the 
bandage was not that of restoring the dislocated extremity of the clavicle im- 
mediately into its proper receptacle on the sternum. This object was accom- 



254 QUARTERLY PERISCOPE. 

plished, in the most gradual manner, by tightening- the bandage every four or 
five days, until the scapulse were completely approximated. The patient was 
confined in bed for three weeks on his back, which greatly assisted the ban- 
dage in its office of retaining the shoulders in the wished-for position. Mode- 
rate pressure was made by the application of soap-plaster on the dislocated 
parts; and, at the expiration, of a month, the parts had acquired their original 
and natural situations." — Med. Chirug. Rev. Jan. 1830, from the Provincial 
Medical Gazette, No. 11. 

67. Dislocation of the head of the Radius backwards. — Two instances of this 
dislocation whicli is considered by Sir Astley Coo]ier as extremely rare, are re- 
lated in the 11th No. of the Provincial Medical Gazette, by Mr. Case. 

68. Vesico- Vaginal Fistula. — These are not very uncommon after tedious 
Jabours, and constitute one of the most troublesome and disgusting infirmities 
to which the female sex is liable. The treatment generally pursued has been 
that recommended by Desault, viz. the retention of a catheter in the urethra 
and the introduction of a plug of some kind into the vagina, in order to keep 
the edges of the fistula as much as possible in apposition. This plan, though 
sometimes successful, has more frequently failed, and is extremely tedious at 
the best. M. Dupuytren has employed the actual cautery in these cases for a 
considerable time and with great success. He prefers it on every account to 
the use of the nitrate of silver, and employs it in the following manner: — the 
patient is placed across the bed upon her belly, with a pillow or two beneath 
her to elevate the pelvis, and her lower extremities out of the bed and held 
by assistants. A speculum in two pieces and hollowed like a flute, is intro- 
duced into the vagina, and the fistula exposed to view. With a cautery 
shaped like a French-bean, named by M. Dupuytren cautere en haricot, the 
edges of the fistula are lightly touched, so as merely to stimulate without de- 
stroying them. The swelling which succeeds this cauterization chokes up the 
fistula for the time, the urine ceases to escape through the aperture, and 
either cicatrization and obhteration are effected or the aperture is much con- 
tracted in diameter. Two or three applications of the iron are commonly re- 
quired, and in order to ensure the free discharge of the urine from the blad- 
der during the process, a catheter may be kept in the urethra. This, how- 
ever, according to M. Dupuytren, is seldom required, and the operation has 
succeeded in a great number of instances at the Hotel Dieu. The most 
favourable cases are those in which the aperture is longitudinal, the most un- 
favourable when it is transverse. In the latter, when accompanied with much 
loss of substance and a considerable communication between the bladder and 
vagina, cauterization will scarcely succeed, and it then becomes necessary to 
resort to otlier means. — Journal Hebdomadaire, No. 58. 

69. Hydrocele of the Spermatic Cord complicated luith Peritonitis, and Consti- 
pation of several days continuance. — The following interesting case of hydrocele 
simulating strangulated inguinal hernia, was treated by Dr. Maclachlak, in the 
Glasgow Royal Infirmary. A child, aged two years, was admitted June 24th, 
1828, with an oblong elastic tumour, about the size of a walnut, in the upper 
part of the scrotum. The testicle was situated immediately below, and poste- 
rior to this tumour, but separated from it. The integuments of the scrotum 
moved freely over, and were not discoloured. The tumour enters, and distends 
the external ring, and is painful when handled. Abdomen is much distended, 
and tympanitic; and the child cries when it is touched, particularly at the lower 
part. No stool for eight days, and for the last two has had nausea and occasional 
retching. Pulse 120; skin hot; tongue white; great thirst. His mother says that 
she first observed this tumour about three months ago, in the situation of the ex- 
ternal ring; and that it gradually enlarged, and descended toward the scrotum. 
She could easily make it disappear by pressing on it; and its disappearance was 



Surgery, 255 

always accompanied by a gurgling noise. She states that she was recommend- 
ed by a surgeon to get a truss to keep it up; that it has continued in its present 
situation for two weeks past; that the child has had no stool for the last eight 
days; and that two days ago, nausea and retching came on, when a surgeon was 
consulted, who attem])ted to reduce the tumour by the taxis, but failed. 

Here, then, were all the symptoms of incarcerated bowel, with a tumour fill- 
ing the external ring, which, from its situation, and the smallness of its size, 
could not, by any possibility, be distinguished from inguinal hernia. The taxis 
was tried, but without any change in the tumour. As the symptoms, as yet, 
were not very urgent, and as the incarceration appeared to be v&iher par engoue- 
ment than strangulation, the boy was ordered, (at 2 P. M.) three grains of calo- 
mel; in an hour after to have ^ij. castor oil, and in two hours more, a laxative 
enema, and to be placed in the warm bath. Should these means afford no re- 
lief, a consultation to be summoned for 6 P. M. 

The enema brought away a pretty large stool, composed entirely of harden- 
ed balls and some blood; but there was no indication of the medicines given by 
the mouth having contributed in any way to it. 

Consultation met at six o'clock. No rehef from the stool. The boy was more 
feverish and restless. Complained more on the tumour being handled. Abdo- 
men still swollen, hot, and tender to touch. Pulse 140. Skin parched. Face 
flushed; in short, a considerable aggravation of all his symptoms. A moderate 
trial of the taxis having again failed, it was decided to open the sac, and ascer- 
tain the nature of its contents. At 7 P. M. this was done in the usual manner, 
and on laying open the investing membrane, a gush of clear fluid, followed 
by a considerable quantity of thick jelly, was pressed out, showing the tumour 
to be hydrocele of the cord. 

The parts were immediately brought together, and ahght compress applied. 
He had three grains of calomel, and afterwards infusion of senna, but it was not 
till the following morning that stools were procured. These were very fetid, 
dark-coloured, and lumpy. He passed a very restless night. Skin excessively 
hot, and feverish symptoms in general increased. Abdomen tense and much 
swollen, and he cries much on its being touched. He was ordered half a grain 
of calomel every four hours. Six leeches to abdomen, and the warm bath. 

26th. Cord and testicle hard and painful; pulse 144; less heat of skin; two 
dark-coloured stools; leeches to scrotum; calomel, and bath to be repeated. 

27th. Feverish symptoms somewhat abated. Swelling of cord as yesterday, 
only there is less redness around wound. Several stools last evening, in which 
there were several lumbrici. Had infusion of senna twice, and the bath. 

29th. Leeches were again applied to-day; and he continued the calomel 
and bath. Abdomen continues enlarged and tender. Passed numerous lum- 
brici, and latterly ascarides in large quantities. Countenance pale, and of a yel- 
lowish tinge. He vomits occasionally. 

2d July. Gradually wasting; abdomen swollen, but soft, occasional retching; 
swelling of cord and testis abating; pulse 160. He continued gradually to de- 
cline during the two following days, and on the evening of the 4th he died. 

Dissection. — Abdomen contained nearly a pint of purulent fluid. The intes- 
tines were enormously distended with flatus, and at some points slightly adhe- 
rent; peritoneum pale, the spermatic cord from testis to inner ring was hard, and 
enlarged to nearly three times its natural size; and within its sheath a small ab- 
scess was found, containing ^]j. of pus. Left side of the chest contained about 
twelve ounces of sero-purulent fluid, and the lung was covered with a thick 
layer of lymph. 

All surgical writers agree as to the extreme difliculty of distinguishing hydro- 
cele of the cord, when small, and when it distends the external ring, from in- 
guinal hernia, even when none of the symptoms of strangulated bowel are pre- 
sent; but when peritonitic symptoms exist, with absence of stools, discrimina- 
tion becomes absolutely impossible. Even Mr. Pott,* a competent judge, one 

• Works, Vol. IV. Case 13. 



256 QUARTERLY PERISCOPE. 

would think, was much puzzled In a case of hydrocele of the cord, where no 
febrile symptoms were present. A lad of 14, had a large tumour, full and tight, 
possessing- the whole spermatic process and scrotum down to the testicle, which 
was independent of it, not tender to touch, unless pressed hard. It bore so hard 
against the opening of the abdominal muscles, that Mr. Pott could by no means 
feel the spermatic process. He had had no stool for five days. *' Some of these 
circumstances were of importance, and might be occasioned by a stricture on 
the intestinal canal; but, on the other hand, his pulse was soft, calm, and quiet. 
His skin was cool; he had neither tight belly, nausea, hiccough, nor vomiting, 
nor any other symptom deducible from such a cause. From the mere appear- 
ance and feel of the tumour, I should have supposed it to be caused by water; 
but the difficulty of distinguishing the spermatic process above, the freedom of 
the testicle below, and the want of stools, made me hesitate." He tried the 
taxis, and not succeeding, he, in the absence of urgent symptoms, gave him a 
purging mixture and an enema, and bled him. His medicine operated in tuo 
hours, and he was relieved. But Mr. Pott was not satisfied. *'I examined it 
again and again, and was still more positive that it contained a fluid; but 
"whether that fluid was in the tunica vaginalis, or in a hernial sac, I could by no 
means be clear. However, as there was no possible method of getting rid of 
it but by an opening, I determined to make one with such caution as to be 
prepared for whatever might happen." The treatment adopted in both cases 
was precisely the same, only in Mr. Pott's case bleeding was had recoure to; 
but surely the diagnosis was much more difficult in my case than in Mr. Pott's. 
Other cases might be cited to prove the difficulty of diagnosis. I shall content 
myself, however, with the following from Mr. Dewar's paper in the Edin. Med. 
and Surg. Journal.* " I was requested by Dr. Stenhouse to visit a patient of 
his, who was labouring under hernia. The man was suffering from pain and 
distention of the belly; frequent vomiting, and obstinate costiveness. There 
was a firm elastic swelling, about the size of a pigeon's egg, occupying the in- 
guinal canal. He complained of very little pain on handling the tumour. 
"When an attempt was made to return it into the belly, it receded in a slight 
degree within the canal; but returned to its former situation immediately on the 
fingers being removed. All the usual means of effecting reduction were tried 
without success, and the operation determined upon. When the tumour was 
opened by Dr. Stenhouse, a small quantity of a glairy fluid ran out, and the 
finger was passed to the second joint, in a shut sac, which had no communica- 
tion with the abdomen. Of course; no relief followed. His bowels, however, 
ultimately yielded, and he got well. I do not yet know, after frequent reflec- 
tion upon this very interesting case, how it could be distinguished with cer- 
tainty from hernia." 

The circumstance of a stool being passed is by no means decisive of the ab- 
sence of strangulation. An enema frequently brings off faeces from the colon 
and rectum, in cases of incarceration. Mr. Tyrrellf mentions a case in which 
even four copious stools were passed, notwithstanding the existence of strangu- 
lation, which afterwards required the operation. *'The sac contained a por- 
tion of intestine highly inflamed, and perfectly incarcerated." The man died, 
and, on dissection, the following is stated as the condition of the gut: — "The 
portion of intestine which had been strangulated consisted of a complete fold 
of the ilium, including the whole diameter of the gut; it had still the mark from 
the stricture upon it, and was much more discoloured than any other part." 
The faeces, therefore, could not have passed this constriction; they must have 
been furnished by the bowel lower down than the point of strangulation. It is 
evident, from the case above detailed, that the child laboured under peritoni- 
tic, and perhaps pleuritic symptoms on admission, the consequence of long- 
continued constipation, and the irritation of worms — That there existed a tu- 
mour in the situation of inguinal hernia, which could not be distinguished from 

* Vol. XXX. p. 44. t Cooper's Lectures, Vol. III. p. 21. Note by Tyrrell. 



Midwifery, 257 

that disease — That the history furnished by the mother was every way calcu- 
lated to mislead — That there was constipation of many days' continuance. The 
taxis having- failed, and the inflammatory symptoms continuing" to increase, 
there was no alternative left for the surgeon. He must have ascertained the 
nature of the contents of the sac; if hernia, he was right; if hydrocele of the 
cord, lie could scarcely be said to be wrong, for this also requires such an ope- 
ration for its cure. — Glasgow MedicalJournal, Feb. 1829. 



MIDWIFERY. 

70. Description of a Cicatrix oftlie Uterus, eight years after the Csesarian Sec- 
tion had been performed. By Professor Mateh, of Bonn. — The patient had been 
operated upon in 1813, by Professor Walther, of Bonn; she died eight years after- 
wards, and her uterus is at present preserved in the Anatomical Museum of 
Bonn. The uterus is of its natural form, size, and consistence; its longitudinal 
diameter being two inches and seven lines, and the distances between the in- 
sertion of the fallopian tubes, one inch and ten lines. At the external surface 
of the anterior paries, a furrow, three lines in length, indicates the place 
where the incision was made; the peritoneum is very firmly adherent to it. The 
edges of the wound were found to have considerably contracted, and appeared 
to be, as it were, turned in towards the substance of the uterus; at the inner sur- 
face the cicatrix was a little more inferior, and larger by half an inch than ex- 
teriorly; it extended as low as the neck of the uterus, where it was one line and 
a half in breadth. The anterior paries of the uterus, in the neighbourhood of 
the cicatrix, was three lines thick; the corresponding portion of the posterior 
paries Vv^as four lines. The cavity of the uterus was perfectly natural, except 
that there was a very thin fleshy polypus at the neck; the left tube and ovary 
were perfectly natural; those on the right were adherent to each other by plas- 
tic lymph. The ovaries exhibited numerous cicatrices. — Loud. Med. and Surg. 
Journ. Oct. 1829. 

71. Procidentia Uteri. By J. J. K?irox. — E. Stivens, set. 20, unmarried, of 
delicate habit, applied to Mr. Knox with a tumour in the vagina, protruding 
between the labia, about four inches in length, of a deep red colour, and ex- 
coriated in a high degree. She complained of general debility; great pain in 
the back and loins and constant bearing down sensation; much inconvenience 
in walking; and pain in voiding her urine which she could not retain so long- 
as she used to do. She stated that the tumour first made its appearance three 
months previous to her application, that then it was small, and had gradually 
increased to its existing size, and that she had been much troubled with 
leucorrhoea. A more minute examination was now instituted. The finger 
could not be introduced into the vagina, nor could the os tincse be felt, but on 
carefully inspecting- the apex of the tumour a small foramen was discovered, 
which easily admitted the blunt end of a probe, and from which a red liquor, 
evidently the catamenial discharge, then present, was oozing. The lips of the 
OS tineas were completely obliterated in consequence of the swelling of the 
parts, and presented a circumference the size of a dollar, in the centre of 
which the orifice into the uterus was placed. The case was obviously one of 
procidentia uteri, and the complete eversion of the vagina accounted for the 
impossibility of introducing the finger. 

Much to Mr. Knox's surprise, gentle pressure on the tumour in the line of 
the axis of the pelvis, the patient being placed upon her back with the liips 
elevated, readily eflTected the return of the prolapsus. Next morning a pes- 
sary was introduced, and answered the intention well in conjunction with in- 
jections of alum and oak-bark. The discharge ceased, the uterus descended 
no more, and the patient experienced no inconvenience from the instrument. 

No, XL— May, 18S0. 23 



258 QUARTERLY PERISCOPE. 

*' Since I met with this case, I have had an opportunity of examining more 
i^lnutely the state of the parts in this disease, in the body of an old woman, 
which I was requested to open. In her, a tumour nearly five inches in leng-th, 
and nine or ten in circumference, protruded between the thighs, presenting 
all the external characters noticed in the above. Being- anxious to have a 
view of the parts within the pelvis, I opened the abdomen for that purpose. 
The protruded vagina formed a large cul-de-sac, in which were contained the 
uterus and its appendages, the bladder and part of the small intestines. The 
parts were much altered and thickened by inflammation, and bound together 
by innumerable bands of new membrane, which could with difficulty be sepa- 
rated by the fingers. The bladder was much smaller than usual. 

" The everted vagina was not unlike to skin, and when cut into, was found 
to be nearly half an inch in thickness, and remarkably hard. 

"Procidentia uteri is, comparatively speaking, a rare disease in young and 
unmarried females. It would appear, that whatever tends to relax or dilate 
the passages, gives a tendency to this most troublesome complaint; and hence 
it most frequently happens to those who have had large families, and who 
have been much troubled with leucorrhoeal discharges. It is very trouble- 
some, and not unfrequently incurable. The urine cannot be retained so long 
as usual, which is easily accounted for; as in the dissection related above, the 
fundus vesicae was dragged along with the uterus, and retained in its new 
situation by membranous bands, which prevented its distention; its passage, 
also, along the tumour, produces excoriation and great uneasiness. In the 
treatment of this formidable disease, it is of the utmost importance, as soon 
as its nature is known, to replace, and retain the parts in their natural situa- 
tion; but it not unfrequently happens, that if they have been long displaced 
and unattended to, it is impossible to do so, and dangerous to persist in our at- 
tempts at reduction, if great difficulty is experienced. In the dissection re- 
lated above, the parts were not only altered in texture, and consequently 
would, if reduced, have operated as a foreign body, but were so bound down 
by adhesions, as would have prevented their reduction, or, if ruptured, have 
occasioned such a degree of inflammation as in the end would have been fatal. 
In old and irreducible cases, therefore, the best and only thing that can be done, 
is to support the displaced parts, in order to guard against their further descent, 
and to protect them from injury. 

"Another interesting fact derived from the above case is the confirmation 
of the already received opinion, that the catamenial discharge is elaborated by 
the uterus, and not, as was formerly imagined, by the vagina, as in this case 
the secretion was seen oozing from the mouth of the uterus, so that, added to 
those related by Morgagni, and Dr. William Hunter, it sufficiently proves that 
the catamenia are secreted by the uterus alone.'' — Medico-Chirug. Rev. Jan. 
1830, from the Glasgow Journal^ No. VII. 



MEDICAL JURISPRUDENCE. 

72. Detection of Arsenic seven years after Death. — M. Orfila communicated 
to the Royal Academy of Medicine, at their meeting on the 1st of December 
last, the following case. In June last, says M. drfila, I was asked whether an 
exhumed body, seven years after burial, would exhibit any signs of poisoning 
by arsenic, and what chemical processes were, in such a case, the best to be re- 
sorted to. My answer was, that at such a period the body would very likely be 
so thoroughly decomposed as to make any inquiry impossible. In case however 
the lateral portion of the vertebral column, especially at the lumbar and dorsal 
vertebrae, were found covered with a blackish substance, this might be acted 
upon in the manner described in my work on poisons. After this question had 
been addressed to me, and I had answered in the above manner, MM. Ozanam 



Medical Jurisprudence. 259 

and Ive, were requested by the *' Procureur du Roi," to proceed to the exhu- 
mation of the body of a person who was supposed to have been poisoned in 
1822. Their inquiries into the cause by which the individual in question had 
died, have been successful, and tend to prove, in the clearest manner, the exist- 
ence of arsenic in the dead body. The following are the details: — 

The grave had been made in a dry and gravelly soil with a small quantity of 
the sulphate of lime, which latter circumstance undoubtedly most contributed to- 
wards the remarkable conservation of the body; the coffin was not in the least 
injured, the bottom only was tinged with a brownish fluid. The identity of the 
body was proved by the *' cure," the grave-digger, and the national guards, who 
had escorted the funeral; besides, the hair of the head had not undergone the 
least alteration, the teeth were still in their sockets, except one canine tooth, 
which the individual had lost before his death; and lastly, the undertaker recog- 
nised the coffin. The head, trunk, and extremities, were in a state of perfect 
integrity; the chest was collapsed; the heart and lungs moulded into a semi-fluid 
mass of black colour, without any smell. The head and extremities were left in 
the coffin, as being useless for the investigation; the mass on which the inquiry 
was to be made was of nine pounds weight, two of which were, however, not 
subjected to the inquiry, but reserved for the repetition of the experiments. 
The substance was boiled several times, and then evaporated to a dry extract, 
which was again dissolved in a sufficient quantity of distilled water. This solu- 
tion was of a dark -brown colour, which was but incompletely destroyed by chlo- 
rine; it was again evaporated, and the remainder detonated with the nitrate of 
potass. The residuum having cooled, was dissolved in a saturated solution of 
nitric acid, and now finally submitted to difl'erent tests, all of which evidently 
showed the presence of arsenic in the fluid. A portion of it being mixed with 
charcoal, and heated in a glass tube, MM. C. and J. succeeded even in reduc- 
ing the arsenic to its metallic form. Another portion mixed with the solution of 
sulphuretted hydrogen, gave sulphuretted arsenic, which being heated with 
caustic potash, gave a bright metallic layer, proved to be soluble in distilled 
water by a current of oxygen. — La Lancctte Frangaise. 

73. Case of Vagitus Uterlnus. — Dr. A. F. Holmes, Lecturer on Chemistry 
and Materia Medica in Macgill College, Montreal, communicated to Dr. Duncan 
the following case: — *' On the 29th November, 1828, I was called to a lady in 
labour of her sixth child. The fontanelle presented, but the pelvis being capa- 
cious, and her labours generally easy, no attempt was made to change the po- 
sition. The head continuing to descend, the mouth lay on the pubis, and the 
examining finger could easily be introduced into it. The occiput did not yet 
occupy fully the cavity of the sacrum. At this time I heard sounds like the 
cries of a child whose mouth was muffled by some covering, but not being very 
distinct, and not being at all -prepared for them, I thought, when they ceased, 
that they must have been produced by flatus in the intestines of the mother. 
In the course of a short time, however, the cries were repeated, and with the 
greatest distinctness, so as not to admit of a doubt that they proceeded from 
the child. The mother much alarmed, inquired the cause of these noises, and 
required to be assured they were not indicative of any danger. The pains be- 
ing brisk, the head was soon forced down and expelled. The child was a fe- 
male, and is still alive and thriving. This case appears to me so curious, though 
easy of explanation, when the position of the mouth is considered, that I am 
induced to draw up this notice, not having met with any thing similar on record, 
and as it is entirely different from the incredible stories we have of the foetus emit- 
ting cries before the commencement of labour." — Ed. Med, and Surg. Journ. 
Jan. 1830. 

74. Poisoning with Acetate of Copper. — A lace-worker, twenty-six years old, 
of a very melancholic tendencj^, and who had attempted to destroy himself with 
ihe water-hemlock five years before, put eight sous pieces into a glass of strong 



260 QUARTERLY PERISCOPE. 

vinegar, and left them there for seven days. At two o'clock of the afternoon, hav- 
ing" made a good dinner, he drank first one-half, and then in fifteen minutes the 
remainder of his potion. Not content with this, he washed the coins in more 
vinegar, brandy, and aniseed water, all of which he also swallowed. Three 
hours afterwards he was found insensible. The muscles were violently convuls- 
ed; the limbs in the intervals of the convulsions were stiff, the teeth set, the 
breathing interrupted, the pulse small, hard, and very slow, the pit of the sto- 
mach tender on pressure. With difficulty he was made to drink some glasses 
of hot water, which, however, did not make him vomit. In half an hour he re- 
covered his senses, and told what he had taken. The white of eggs was imme- 
diately given in large quantity. The convulsions afterwards ceased rapidly, but he 
continued to hiccup till two in the morning. Next morning the pulse was full, 
slow, and intermitting: the belly drawn in, hard, and very painful on pressure; 
the skin pale; the convulsions partial and transient. Leeches were directed to 
be applied to the abdomen, and afterwards poultices; at the same time the 
white of eggs were persevered in; and the warm bath, with mild opiate injections 
were used. In the evening he had colic, dyspncea, great agitation, hiccup, and 
a hard contracted pulse. The leeches were repeated. The urine at this time 
was scanty and scorching. He passed an indifferent night, but next morning 
was easier. The abdomen was not tender, the pulse was soft, and the urine 
was natural in quantity. In fourteen days after his admission he was dismissed 
cured. — Revue Medicale, Sept. 1829. 

73. Determination of the Period that a Browned Body has been in the Water. — 
As the means of ascertaining, very nearly, the time which a dead body has been 
under water, may prove in some cases to be important in a judicial investiga- 
tion, M. Alph. Devebgie was authorized by the prefect of Paris, to observe 
and open the subjects deposited at the Morgue, a place to which all bodies are 
brought that have died by unknown means, or which are found in the public 
places of that city or in its neighbourhood. The number annually brought there 
is about three hundred. 

After much investigation, M. A. Devergie assigns the following characters as 
the means of deciding the length of time the body has been submerged, sup- 
posing the weather to have been cold. 

1. From three to five days. — Rigidity of the corpse; coldness; no contraction 
of the muscles by electrical stimulus; the epidermis of the hands beginning to 
whiten. 

2. From four to eight days. — Suppleness of all the parts; no contraction 
from electricity; colour of the skin natural; epidermis of the palms of the hands 
very white. 

3. From eight to twelve days. — Flaccidity of all the parts; epidermis of the 
backs of the hands beginning to whiten; face softened and presenting a wan 
appearance, different from that of the skin of the other parts of the body. 

4. About fifteen days. — Face slightly swelled; red spots; greenish tint of the 
middle of the sternum; epidermis of the hands and feet totally white and begin- 
ning to fold. 

5. About one month. — Face red, brownish; eyelids and lips green; breast 
reddish-brown and greenish in front; epidermis of the hands and feet white, 
loosened and folded as if by poultices. 

6. About two months, — Face generally brownish and swelled; hair rather 
loose; epidermis of the hands and feet in a great degree detached; nails still 
adherent. 

7. Two months and a half. — Epidermis and nails of the hands detached; epi- 
dermis of the feet detached, nails still adherent; in females, redness of the sub- 
cutaneous cellular tissue of the neck, of that which surrounds the trachea and 
organs in the cavity of the breast; partial saponification of the cheeks, of the 
chin, superficies of the breasts, groins, and anterior part of the thighs. 

8. Three months and a half. — Destruction of part of the scalp, eyehds, nose; 



Chemistry. 261 

partial saponification of the face, superior part of the neck and groins; corro- 
sion and destruction of the skin on various parts of the body, epidermis of the 
hands and feet completely removed; nails g-one. 

9. Four months and a half —Almost total saponification of the fat of the face, 
neck, groins, front of the thighs; commencement of a calcareous incrustation 
upon the thighs, and a saponification of the anterior part of the brain; most of 
the skin opaUne; loosening and destruction of almost the whole of the scalp; 
scull bare, beginning to be very friable. — Annales d' Hygiene publique, Odoher, 
1829. 



CHEMISTRY. 

76. Chemical Constitution of Acetic Ether. — By a series of experimental re- 
searches, M. Plakiava has arrived at the conclusion, that acetic ether is fcrm- 
<ed of one equivalent of acetic acid, and two equivalents of alcohol; that there- 
fore it is a sub-acetate of alcohol, and is represented by the No. 97. — Kastnei-'s 
Archives. 

77. New Proximate Principle from Albumen. By M. Coueree. — White of egg 
was left to itself at a temperature of 17*^ or 18° F. It did not congeal, but thick- 
ened a little, and at the end of a month gave an abundant membranous net- 
work and a liquid matter, no putrid gas having been disengaged. The liquid 
was slightly examined, and by its decomposition gave carbonate of ammonia; 
hence it was concluded that the liquid contained the animal part of the albu- 
men. 

The membranous substance was white, translucid, and of a foliaceous struc- 
ture, insipid, inodorous, and friable. Heated in a tube, it did not fuse, but was 
decomposed, swelling at the time, evolving no azoted products, but leaving a 
voluminous light charcoal difficult to burn. When decomposed by oxide of 
copper, it gave only water and carbonic acid. In cold water it did not dissolve: 
in boiling water it softened, melted, and looked like insoluble mucilage. Al- 
cohol, ether, and acetic acid extrted no action upon it, hot, or cold. Sulphu- 
ric acid exerted little action at common temperatures; but by heat carbonized 
it, evolving an agreeable aromatic odour. Nitric acid acted but little when cold, 
by heat dissolved it, evolving nitrous gas. Muriatic acid dissolved it when heat 
was applied, and the solution remained clear on cooling; by dilution, a fine 
white powder was deposited. 

Potash, with heat, dissolved it, and rendered tiie solution turbid, but did not 
cuuse any deposition in twenty -four hours. — Annates de Chimie, Vol. XLl. 

78. Preparation of Urea. By M. IIE^'^B.Y. — Let a slight excess of the sub-ace- 
tate or the hydrate of lime be added to recent urine; a precipitate will fall 
which will contain salts formed by the union of the acids in the urine with oxide 
of lead, and also a combination of tlie mucus and animal matter present with the 
hydrate or subsalt used. 

The clear fluid is to be acted upon by diluted sulphuric acid, added until in 
slight excess, to separate the lead present, and to act, during the future evapo- 
ration, upon the acetates of soda and lime which may be formed. The liquid is 
again to be freed from the precipitate, and quickly evaporated, animal charcoal 
being added to it during the ebullition. A¥hen clear the fluid is to be strained 
through a fine cloth; and concentrated to one-third of its bulk; on cooling, it 
will probably become a yellowish acicuJar crystalline mass, consisting of much 
urea and some salts. The crystals, when drained and pressed, are to be added 
to those produced by evaporating the mother water, also similarly treated; be- 
ing thus freed from the brown viscid matter which previously accompanied 
them, they are to be treated with a small quantity of carbonate of soda, to de- 



262 QUARTERLY" PERISCOPE. 

compose any acetate of lime which may remain, and then are to be digested in 
alcohol. The solution, filtered and distilled, leaves urea, which may be re- 
crystallized by solution in water and evaporation. — Journal de Pharmaciey 
April, 1829. 

79. Preparation of Hydriodic Ether. — M. Serullas proposes the following 
process for obtaining this compound: — put into a tubulated retort, iodine, 40 
parts^ alcohol, 100 parts; phosphorus, 2| parts. The latter is to be added in 
small fragments, and the retort is to be shaken; the distillation is to be conti- 
nued nearly to dryness; then stopping it, add 25 or 30 parts of alcohol, continue 
the distillation, and cease at the same point as before. Water being added to 
the product, the ether is immediately separated and sinks; it is to be washed in 
the usual way, and redistilled from some fragments of cslcuim.— Philosophical 
Magazine, Jan. 1830, from Schweigger's dnnals. 

80. Means of Detecting Hydrocyanic Acid. By M. Orfixa. — Pure hydrocyanic 
acid, either anhydrous or hydrated, is best detected by its odour, which is ana- 
logous to bitter almonds, or by the nitrate of silver, which acts on this acid in a 
way not heretofore understood. When this salt is added to a mixt^ure containing 
the smallest quantity of the acid, it throws down the cyanuret of silver in the 
form of a white curdled precipitate, heavy, insoluble in water, and very nearly 
so in cold nitric acid; but very soluble in boiling nitric acid, and in ammonia; it 
has very little tendency to change to violet, is decomposed by heat and expo- 
sure to the air so as to furnish metalhc silver and cyanogen: the gaseous cya- 
nogen being easily recognised by its burning with a purple flame; the cyanuret 
of silver need not be confounded with any other substance. The test proposed 
by M. Lassaigne, the deuto-sulphate of copper with a small quantity of potash, 
has the inconvenience of affording a whitish precipitate that may be confound- 
ed with many other substances; whilst the per-sulphate of iron, added to a mix- 
ture containing hydrocyanic acid, to which a little potash and sulphuric acid 
has been added, produces a blue precipitate, (Prussian blue;) not so sensible, 
it is true, as M. Lassaigne's test, but more satisfactory. 

If the mixture to be examined be so coloured as to furnish broMm precipitates 
with the nitrate of silver or the per-sulphate of iron, then a slip of white paper, 
previously impregnated in a solution of pure potash, is to be immersed into it for 
two or three minutes, withdrawn and dried. If a few drops of the trito-sulphate 
of iron, dissolved in a small quantity of water be dropped on this paper, the 
parts touched will immediately assume a blue, verging on a green, should it be 
impregnated with the hydrocyanate of potash. — Archives Generates, July, 1829. 

81. Analysis of Bile. By HE]5rRr Bkacojvngt. — From the uncertainty which 
still hangs over the composition of this fluid, so important in the animal eco- 
nomy, this able chemist has been induced to examine afresh, the matter which 
constitutes the essential portion of ox-bile, viz. the picromel. His memoir, 
which occupies twelve pages of the Annales, furnishes the following results. 

I. That bile is a true soap, as the ancient physicians had determined. II. 
That the picromel of the ox contains: — 1. A pecuhar acid resin, which forms 
the greater portion of it. 2. Margaric acid. 3. Oleic acid. 4. An animal 
matter. 5. A very bitter substance, of an alkahne nature. 6. A colourless 
saccharine principle, which becomes purple, violet and blue, by sulphuric acid, 
7. A colouring substance. — Ann. de Chim. Oct. 1829. 

82. Discovery of a New Principle in the Moot of the Ca'i'nca. — M. Caventou 
communicated to the Academy of Medicine, at their sitting of the 12th of Sep- 
tember last, that he had discovered in the root of the cainca a peculiar princi- 
ple, very bitter, white, crystallizing in the form of needles, soluble in alcohol 
and the alkalies, and reddening the tincture of tournesol. He thinks that M. 
Brandes is deceived in believing that there exists in the cainca a substance 



Miscellaneous. 263 

analogous to emetin. M. Caventou has also found in this article another sub- 
stance very white, very little soluble in water, unless a little ammonia be add- 
ed to it; it appears in g-elatinous, trembling- masses, resembling" peptic acid. — 
La CUnique, Vol. I. No, 14. 



MISCELLANEOUS. 

83. Mortality of Paris. — The bill of mortality for Paris, during- 1828, like 
that for the year preceding, presents, according to a classification of deaths 
founded on their causes, the exact amount of mortality in each arrondissement 
and quarter, both in the city and in the various hospitals in its vicinity. That 
the influence of local causes maybe better understood, particular care has been 
taken to separate the deaths of those that had resided in Paris only a few days, 
and who had consequently not been subjected to them. 

To the amount of deaths in each district produced by phthisis pulmonalis, 
those produced by pulmonary catarrh have been added, and this view seems to 
show that the same causes tend to produce the two diseases at different periods 
of life; for in all the quarters presenting the greatest mortality from consump- 
tion, the number of deaths by pulmonary catarrh are also greatest. 

The whole amount of deaths for the year 1828 is 24,299; in 1827 it was 23,241, 
which affords an excess for 1828 of 1058. In this total number there were 11,430 
deaths of males, and 12,859 of females. 

In the classification of deaths according to the order of their most frequent 
causes, we find as usual pulmonary consumption at the head of the hst. There 
perished by it 1133 males, and 1526 females. The periods of life when this dis- 
ease has had most victims were from fifteen to forty-five with females, and 
twenty to thirty-five with the males. Chronic pulmonary catarrh, which we 
associate with phthisis, has destroyed 688 men, and 851 women, most of whom 
were swept off between the ages of fifty and ninety. Under the head of gastri- 
tis, the deaths amount to 922 males and 1124 females; whilst under that of en- 
teritis, they amount to 1018 males and 1122 females. These two diseases have 
been particularly fatal during- the first years of life. Of peritonitis there died 
141 males and 407 females. With the first the mortality was greatest from the 
age of fifteen years and upwards; but with the women, from fifteen to forty -five. 
Inflammation of the brain and that of its membranes proved fatal to 254 males 
and 206 females, the greatest number of which died in the three first months of 
infancy, and in the period between the fifteenth and seventieth years. 1042 
males and 1169 females fell victims to inflammation of the lungs, from the age 
of fifteen and upwards, and especially in the three first montns and during- the 
three first years. Apoplexy occasioned death in 477 males and 430 females. 
Scirrhus, cancer, and chancrous ulcerations, proved fatal to 174 males and 541 
females, these diseases having been most destructive from the age of thirty and 
upwards. Aneurism of the heart proved mortal to 223 males and 286 females, 
of the age of twenty years and upwards. 

The deaths by fevers presented the following order: Cerebral fever carried 
off 339 males and 340 females, most of its victims having been between the sixth 
month and sixth year; the fever called mahgnant, (or ataxic,) 97 males and 95 
females; putrid, (or adynamic,) fevers, 90 males and 91 females; the fever called 
bilious, 65 males and 54 females. It thus appears that the proportion of sexes 
in which these fevers proved fiital was nearly equal, whilst the greatest morta- 
lity was from the fifteenth year and upwards. 

Among the diseases to which infancy is most subject, convulsions proved fatal 
to 889 boys and 852 girls, most of whom were in the three first months of fife, 
or from one to four years of age; teething, 154 boys and 161 girls; measles, 120 
boys and 202 girls; small-pox, 85 boys and 35 girls; hooping-cough, 78 boys and 
82 girls; croup, 77 boys and 75 girls. The number of premature births and 



264 QUARTERLY PERISCOPE. 

dead-born, was 682 males and 564 girls ; and those which have fallen victims to 
debility during" the three first months amount to 215 boys and 298 g-irls. 

An examination of this exposition of the principal causes of mortality shows 
us, that phthisis, pulmonary catarrh, enteritis, gastritis, and inflammation of the 
lungs, present themselves in the first rank, having occasioned nearly four-fifths 
of the whole mortality. Phthisis and pulmonary catarrh have still, as in pre- 
ceding years, selected most of its victims from the female sex; and the same 
observation will apply to cancerous affections and peritonitis. 

With infants the most fatal diseases have been convulsions and measles. The 
smali-pox has carried off nearly twice as many males as females, a disparity 
which is doubtless explained by the fact that parents have less regard for the 
beauty of their boys than their girls, and are thus less particular in having the 
former vaccinated. The number of deaths by small-pox has nevertheless dimi- 
nished, which shows that the prejudice which has opposed the spread of this 
happy preservative is daily yielding before the multiplied proofs of its efficacy. 
— Raport General des travaux du conseil de salubrife de la ville de Paris^ pour 
I' anne Cy 182S. De Moleons Recueil Industriel. 

84. Mortality in the Different Classes of Society. — M. Dumeril, at the meet- 
ing of the Academy of Medicine, August 3d, made a very favourable report of 
a memoir of M. Benoiston, de Ghateau-neuf, on this subject. The principal re- 
sults obtained are, that the mortality is greater among the poor than among the 
rich, and the duration of life increases in mountainous countries. M. B. has 
observed six hundred persons in high classes of society, as sovereigns, peers of 
France, cardinals, ministers, &c. during a period of eight years; and during this 
period, one hundred and forty-one have died, or nearly a fourth. Analogous 
observations made on poor inhabitants of the faubourg St. Marcel give a mor- 
tality almost double. — Archives G&n&raleSy Nov. 1829. 

85. Vaccination. — It is stated in the Journal U?iiversel for July last, that Dr. 
Barkes, Jr. of Bordeaux, vaccinated a child three years of age, making four 
punctures, from which no effects resulted until about two months afterwards, 
when two genuine vaccine pustules were developed, from which other chil- 
dren were successfullv vaccinated. 



( 265 ) 



AMERICAN INTELLIGENCE. 



€ase of Ozena cured by the use of Chloride of Lime. By W. E. Hors-er, M. D. 
Adjunct Professor of Anatomy in the University of Pennsylvania. — The acknow- 
ledg-ed difficulty of curing- ozena or chronic purulent discharge from the nostril, 
makes this disease in the estimation of experienced surgeons one of the most 
untractable that they are called upon to treat. Mr. Boyer, after most extensive 
opportunities, admits that it is absolutely incurable, and this opinion is sustain- 
ed by other persons of equal celebrity, among- whom I may mention Dr. Phy- 
sick. Under these circumstances, even a partial observation of a remedy en- 
tirely successful, may be considered worthy of attention, and subsequent trials 
will tend to establish how far it may be relied upon in cases generally. 

In October, 1828, Luke Johnson, a black man, aged about thirty, of good 
constitution, was brought from Virginia by his master to be placed under my 
care for ozena. At this period there was a large discharge of intolerably foetid 
matter from both nostrils, most abundant in the morning after waking; his nos- 
trils were then filled with it, and on blowing them, immense quantities would 
be discharg-ed, part being in a fluid purulent state, and the remainder dried into 
tenacious yellow plugs; during the night much of this matter ran into his throat, 
and by its ofFensiveness produced severe sickness of the stomach, and sometimes 
a loss of appetite the next day. The discharge also existed during the day, but 
as he could then keep his nostrils clear of an accumulation, he suffered less at 
that period. He occasionally had head-aches, especially when the quantity of 
the discharge diminished. 

The following statement in a letter dated Sept. 16, 1828, from his attending 
physician, the late Dr. Spence, marks the progress of his complaint, and the 
mode of treatment which had been resorted to. " Luke Johnson has for a long 
time laboured under a distressing pain in the head, and particularly in the frontal 
sinuses, with a discharge of offensive matter from his nose. He has not long 
been a patient of mine; all the remedies he has used have been unavailing. 
About three years since he first complained of pains in his head, which he 
ascribed to sleeping in a damp cellar. A short time before I took my last trip 
to your city, (August, 1828,) I was consulted on his case. He then complained 
of severe pains in the frontal sinuses, accompanied with a discharge of very of- 
fensive matter from both nostrils. He had taken a variety of medicines, chiefly, 
I beheve, of a purgative nature, without benefit; and he was a good deal re- 
duced in flesh. As he had a thick mass of hair on his head, I directed it to be 
cut off, applied blisters to his forehead, and put him on an alterative course of 
mercury combined with a small portion of opium. When his gums became affect- 
ed, I advised him to leave off the mercurial pills. This course he had commenced 
before I left Dumfries, and since my return he has informed me his mouth had 
been sore; the blisters had drawn well, but without aflTording him relief. He 
also used a weak solution of sulph. cupri as a detergent wash, which he thought 
beneficial, as it caused a free discharge of pus from his nose; for when this dis- 
charge is checked he is almost distracted. He is a man of great veracity, and 
assured me he never had had any syphilitic affection." 

Despairing in this case of the efficacy of the usual routine of practice, I deter- 
mined to begin at once with the application of a solution of chloride of lime. 
Dr. Physick's advice being also taken, with his characteristic candour, he ac- 
knowledged the inefficacy of such remedies as he had been in the habit of using, 
and he readily acquiesced in the plan of treatment proposed. I accordingly be- 



266 QUARTERLY PERISCOPE. 

gan by putting- about a tea-spoonful of the chloride of lime in a wine-glassful of 
water, and I injected each nostril with the clear solution. This process was re- 
peated twice a day for a week. During- this time it produced no important dimi- 
nution of the discharge, but it made the patient more comfortable by correcting 
the foetor. At the expiration of the week, Luke went home with directions to 
persevere in the treatment. The sequel will be seen in the following commu- 
nication to me from Dr. Thomas M. Bovle, dated Dumfries, Virginia, April 13, 
1830. 

" On my return home, in conformity to your request I called on your patient, 
negro Luke Johnson. He stated that by the use of the chloride of lime, as re- 
commended by yourself, his nasal affection ivas entirely cured in December last. 
Since then his general health, which before did not suffer much, has been re- 
markably good." 

I may further state, that since the occurrence of this case, the chloride of 
lime has been used with evident advantage, in another of a year's duration, 
where the affection is confined to one side; but the treatment has not progressed 
far enough for a positive and satisfactory result. In this case the application of 
the lime by snufhng is followed instantly by a discharge of several drops of se- 
rum; afterwards, pure transparent mucus is secreted abundantly for the remain- 
der of the day, attended with frequent sneezing and all the local symptoms of 
influenza, with a perfect arrest for the time of purulent discharge. The nostril 
is caused by the application to bleed frequently; this circumstance has made me 
hesitate in the regular application of the remedy. I have also prescribed it in 
a very severe case of three years duration, and on both sides, but of the result 
I am not yet informed. 

As cases of ozena do not frequently occur in the practice of an individual, I 
trust that this suggestion of chloride of lime as a remedy will be candidly tried 
by others, and their experience communicated. "We have some accounts of its 
being used successfully in caries of the bones of the nose, which will be an ad- 
ditional incentive to a fair experiment of its value, in chronic purulent discharge 
from the nostril. 

New Bullet Forceps. — This ingenious instrument is the invention of Mr. 
William JoifEs Mabeira, of Chambersburg, Pennsylvania, student of medicine. 
It consists of a canula which is divided at one extremity so as to form two forcep 
blades, the ends of which are toothed; at the other extremity it terminates in a 
button. Through tliis canula a rod passes, at one extremity of which is a handle, 
and to the other two screws are attached, one each side; the shaft of the screw 
passes through a groove in each blade of the forceps, this groove being of such 
a size as not to permit the passage of the head of the screws which are on the 
outside of the blades. The blades are bent, so that when the rod is drawn 
down, they separate; when the rod is pushed up, the blades are drawn together 
by the heads of the screws attached to its extremity. The instrument is so sim- 
ple and so well represented in the accompanying drawings, which afford two 
views of the instrument, one with the blades open, the other with them closed, 
that it will be at once understood, without any further description. It is in- 
comparably the best bullet forceps that we have seen, and will be useful for 
several other purposes in surgery. 



American Intelligence, 267 

Fracture of the Coronoid Process of the Ulna. By William M. Fahnestock, 
M. D. — This is an accident of rare occurrence: the only instances we have no- 
ticed on record, came under the care of Dr. Phtsick and Sir Astlet Cooper. 
A boy, living- with Major Benjamin, of Harrisburg", fell from the hay-mow, and 
received the whole weight of his body on the back part of the palm of the left 
hand, whilst the arm was extended forwards, by which impulse the coronoid 
process of the ulna was displaced, and presented the appearance of a disloca- 
tion of the forearm backwards, but which on being reduced would be repeated, 
attended by an evident crepitation. Assisted by my preceptor, the late Dr. 
Martin Luther, the fracture was adjusted, and secured in the angular splints of 
Dr. Physick, and recovered very speedily. 

Fracture of the Condyles of the Os Humeri. By William M. Fah7<j-estock, 
M. D. — Nathan, son of the Rev. H. P. J. a boy eight years of age, while play- 
ing" with his school-fellows, June 18th, 1824, was thrown with considerable force 
against the edge of a rock, then fell upon the arm and forced it into a fissure, 
by which the condyles of the os humeri were fractured and separated, leaving* 
a very sharp pointed shaft, which partially penetrated the anterior part of the 
capsular lig-ament. The usual dressings were applied, and after the bones be- 
gan to unite, the whol6 apparatus was daily removed to exert gentle flexion and 
extension, which was gradually increased, and after six weeks attention, reco- 
vered with the perfect use of the joint. 

We believe from the above case, that much more might be effected in cases 
of injury of the joints than we usually anticipate, by early and long-continued 
perseverance in removing* the dressings, and giving judicious extension to the 
member. The great error we believe to be delaying the flexion and extension 
to too late a period, and we have not the least doubt that anchylosis and per- 
manent deformity were avoided, by commencing the exercises of the hmb a few 
days after the reduction. 

Dengue. — We have endeavoured to keep our readers informed of all the 
facts in relation to this curious epidemic, which has excited so much attention, 
and with regard to the character and best mode of treatment of which, so much 
diversity of opinion prevails. In the Edinburgh Medical and Surgical Journal^ 
for January last, are two papers on this disease, one by W. H. Cock, M. D, 
giving an account of the disease as it occurred at St. Bartholomews, the other 
by John Furlonge, M. D. describing this affection as it appeared at St. Johns, 
Antigua. We find nothing new in the accounts of either of these writers, and 
shall only observe that the first considers the disease contagious, and propagated 
by contagion, and that the other entertains the opposite opinion. William R. 
Waring, M. D. of Savannah, has published in the North American Medical and 
Surgical Journal, for April last, a memoir on this subject, in which he presents 
the most satisfactory and lucid views of the pathology of this disease that we have 
met with. " The pathology of Dengue," says Dr. Waring, *' consisted in pri- 
mary irritation of the mucous membrane of the stomach or of the stomach and 
intestines. The accelerated efforts of the heart, the inflammation of the skin 
and joints, I consider to have been sympathetic revulsions, and secondary. The 
gastric irritation did not at all times perceptibly precede the secondary affec- 
tions, as in pleuritic fever, where the stitch under the ribs and the febrile 
movements of the heart which result from it, seem to be concurrent, without 
being so in reality. But in almost all cases, the incipient irritation was mani- 
festly, as well as truly, antecedent to its effects. The patient was first affected 
as in ordinary autumnal fevers, with the same predisponent symptoms which 
are now generally understood to be indicative of the gastritis initiatory of that 
diseasfR; such as sense of universal indisposition, indigestion, loss or excess of 
appetite, nausea, chilly sensations, erratic uneasiness, head-ache, constipation, 
foul tongue, and foul taste. The similitude did not stop here. After the predis- 
position was passed, and especially if the pains were moderate, which some- 



268 QUARTERLY PERISCOPE. 

times happened, it continued into the febrile paroxysm; so that the distinction 
could not be affirmed, until the eruption had been developed. I remember the 
case of a gentleman who had exposed himself in the country on an excursion to 
his farm. He was violently attacked with every symptom of common fall fever; 
a chill, numerous pains, distress in the loins, abundant vomiting-s of bile, and an 
intense fit of arterial excitement. I was satisfied that this was a bilious gastritis 
contracted from the miasma of a marsh, and did not discover my mistake until 
the skin became inflamed. Hence I am permitted to consider dengue as based 
in gastric or gastro-enteritic inflammation, for as good reasons as I attribute our 
annual remittent to that origin. The first morbid impression liaving been made 
in the mucous membrane, the system underwent what the nosological gentle- 
men call a collapse. This, as in every form of fever, was the period of greatest 
suffering to the patient. About twelve hours having elapsed, a centrifugal re- 
vulsion took place, the internal oppression decreased, while the external ex- 
citement proportionally increased; the vascular action was altered. The pulse 
became full and soft, skin permanently warm, cheeks flushed, eyes red, gene- 
ral distress moderated, the pains confined and riveted to the joints. In a short 
time the efforts of the heart relaxed, the heat lessened, and an eruption was 
thrown out. The primitive irritation had evidently undergone a transposition 
by a critical act of the superficial capillaries and parts appertaining to the joints. 
The patient now commenced to convalesce; he got out of bed with difficulty, 
and moved about stiffly and contorted. The disorder which had been excited 
in the stomach remained in some cases for a length of time in a subdued or sub- 
active state; but for the most part it went off", particularly in young persons, 
gradually and entirely. 

" As it was very soon understood that the disease passed away in a great mea- 
sure by irritation of the skin, some persons attempted to drive it into this part 
by the obsolete method of administering stimulant substances during its pro- 
gress. These attempts, instead of expelling the gastritis, augmented it; they 
operated as such a course is known to do in the contagious exanthemata. I 
have seen what ought to have been a simple erythema exalted into an erysipe- 
las, thickening the skin, descending and bloating the cellular tissue beneath, 
and yet without curtailing the fever in the least degree by these pernicious ef- 
fects. I have reason to think, moreover, that this kind of treatment, pursued 
even after the regular subsidence of the active symptoms, was sometimes the 
efficient cause of certain cases of relapsed dengue under a distinct form. These 
cases were serious or deadly, and assumed the aspect of bilious fever, yellow 
fever, dysentery, or acute pneumonia, without evincing the external or secon- 
dary irritations at all. The limbs and skin refused to participate in the disease, 
and by defect of the counter-excitement, of which they ought regularly to have 
been the seat, was occasioned, or intermediately estabhshed the aggravated 
violence which characterized them. But the direct propellant was the opera- 
tion of undue excitants upon parts still morbidly irritable, or still actually in- 
flamed. The secondary were swallowed up in the primary aff'ections, as in 
small-pox, measles, erysipelas, where the cutltis has receded, v\^ithout passing 
through the regular stages. The exanthemata are mild diseases, by the circum- 
stance of being exanthematous; the inflammation of the skin makes them so. 
But when by accident or imprudence, the establishment of the eruption has 
been thwarted, or, after the establishment, it has been prematurely removed, 
they are understood to be among the most mortal maladies to which we are sub- 
ject. Under such circumstances, I know nothing to which they may be more 
pertinently compared, than an explosion of gunpowder within a barrel, having 
its muzzle closed. The expanded air bursts the implement, because it is not 
permitted to escape. The following is the history of a case of this non-eruptive 
dengue. 

"H., a black, aged twenty-two years, short, well-built, healthy, a native, 
was seized 6th of October, 1828, with the ordinary symptoms of dengue, which 
at the same juncture was prevailing among the family and servants of the 



American Intelligence, 269 

hdUse. No festi'ictlons were enforced upon the habits of this patient, as no 
danger was anticipated, and it was expected he would immediately, and with- 
out difficulty, pass through the disease, as every one was doing at the same pe- 
riod. Several days had elapsed, no eruption appeared, the pains subsided; but 
it began to be perceived that the case assumed serious and unusual symptoms. 
A physician was then sent for. No diary of the incidents was kept, though they 
were as accurately sketched as practicable after death took place, and were 
as follow :-*During the first days after the adverse change,^ fever of a double 
tertian type, the principal paroxysm always beginning with a chill, nausea, and 
discharges of bile upwards and downward; conjunctiva, skin and urine tinged 
with bile; last three days, obliteration of the remittent forms, cessation of nau- 
sea and vomiting, evacuated urine but once, and in small quantity, harassed by 
constant hiccup, amounting sometimes to cramp; pain of lumbar region, which 
"was intolerably aggravated by pressure of the hand; till thirty-six hours before 
sieath pulse vigorous but slow; intellect good to the last. In consequence of 
great intestinal irritability, slimy evacuations were procured, at first by very 
minute doses, at the last they became abundant without the aid of medicine. 
Treated with oil, sinapisms, blisters, and diluents. Took evening before death 
a small quantity of sub-carb. soda, which he said burned his stomach. Death 
took place on the eighth day from the commencement. 

'* Examination post mortem. Contents of thorax sound; but pushed into the 
upper parts of the cavity by excessive convexity of the diaphragm. Liver large, 
slate-coloured; when cut it bled freely; was attached peculiarly: instead of be- 
ing fixed in the right hypochondrium, it adhered to the diaphragm at the epi- 
gastrium, as if dislocated from the side to the middle; it was lodged in the cen- 
tre of the cup of the diaphragm, and occupied a great portion of the cavities of 
the chest. This elevated position in the chest will not be attributed to acci- 
dental fulness of the bowels, or constriction of the abdominal muscles, but to 
iiatural deficiency of space in the chamber of the abdomen, and greater expan- 
sion of the ribs than is usual. The whole abdominal contents were thus pressed 
upwards by the abdominal walls, so that the outward figure presented the ap- 
pearance of having been tightly corseted. The gall-bladder contained some 
dark viscid bile, but was not filled as it is usually in cases which are exclusively 
bilious. The mucous membrane of the stomach, duodenum, and small intes- 
tines was inflamed; on holding it up to the light and stretching it, innumerable 
vessels were seen injected with blood, and ramifying through it. These 
branches were more abundant about the rugae than elsewhere; the number de- 
creased in descending through the intestinal tube, but were quite numerous in 
both jejunum and ileum. The spleen presented the natural size, but was soft 
and muddy. Pelvis of right kidney inflamed; substance of left kidney altered, 
appearing and cutting like cartilage; its pelvis inflamed, almost obliterated, and 
containing a thin purulent fluid. I should think it had ceased to secrete. Blad- 
der sound. Neither the stomach nor intestines contained any bile. 

"I consider this case to have commenced in fact after the subsidence of re- 
gular dengue, and as divided into two parts:— the bilious, in which irritation of 
the liver was conspicuous, and intense gastro-enteritis, in which that irritation 
seemed to be suppressed. The former constituted the first, and the latter the 
second stage of the case. As the gastro-enteritis increased, the bilious secretion 
and periodicity of the first disappeared. The gastro-enteritis did not reach the 
intense degree which effects the black exudation from the mucous membrane, 
as in yellow fever, though it bordered upon it; nor was the liver in the dry and 
bloodless condition which it usually assumes, though the suppression of the bi- 
lious secretion evinced that it was tending towards it. This case presented in- 
deed a curious blending of the symptoms and anatomical derangements which I 
have so frequently observed appertained to both the yellow and bilious fevers 
of this city. The gastro-enteritis appears, in the first instance, to have been 
slight, but sufficient to kindle in the liver an irritation more impetuous proba- 
bly than itself, and an activity of the secreting vessels which filled the whole 

No. XL— May, 1830. 24 



270 QUARTERLY PERISCOPE. 

body with bile: it afterwards increased, and swallowed up the hepatic irrita- 
tion which it had produced, as happens in nine cases out often of black vomit. 
Such were the ravages which seem to have arisen from what ought to have been 
but simple dengue, by its reflection upon vital organs, or its retrocession from ex- 
ternal parts. Had the joints and skin been permitted in this case to be in- 
flamed, it would probably have terminated in prompt recovery, as happened 
invariably when the disease was conducted through its proper course. The 
violent alteration which took place in its character, it is to be supposed, result- 
ed from the careless self-management of the patient, in conjunction with a pe- 
culiar susceptibility of excitement in the vital parts affected. 

*' As no case of regular dengue terminated mortally, it is not in my power to 
furnish any example of the morbid anatomy of its simple state, and to demon- 
strate, through this corroborating means, its gastro-enteritic character. Neverthe- 
less, the preceding case just recounted ought to suffice, since it appears to have 
been different from the original affection in nothing but defect of the external 
inflammations. It was indeed the original gastro-enteritis rekindled and aggra- 
vated, or aggravated without being" rekindled, and divested of the secondary or 
external characteristics. The pathology of dengue thus exhibited, assimilates 
it curiously to three different diseases of gastro-enteritic foundation, namely, 
gout, erysipelas, and yellow fever. By inflammation of the joints to the first, 
by inflammation of the skin to the second, and by absence of both these in- 
flammations to the last. Or, in other words, gout might be considered dengue 
without eruption, erysipelas a dengue without affection of the joints, and yellow 
fever a dengue concentrated upon the bowels. Perhaps I could not communi- 
cate my view of the disease in any other manner more perspicuously than I have 
thus ventured to do by this threefold comparison. 

*'If I were required to explain why dengue, being a gastro-enteritis, compli- 
cated the skin and the joints, it is quite possible, however well sustained I 
might be in the facts, that I should not do it with perfect success. That it was 
owing to the direct operation of some peculiar property of atmosphere upon the 
organs, or to some peculiar relative condition of sympathies impressed by cli- 
mate, and circumstances, there can scarcely be any doubt. The specific sym- 
pathies excited by medicines which are first made to act on the stomach, is a 
profound mystery. The different sympathies excited by the same medicine, in 
diiterent constitutions, is just as much so. Physiology is too imperfect to serve 
us in this recondite matter. In the same manner, inflammation of a part by one 
agent shall elicit specifically effects in other parts, which inflammatian of the 
same part by another agent shall be incapable of producing. And what is still 
more remarkable, an inflammation effected by the same agent, at different times, 
will often, even in the same subject, give rise to different secondary results. 
Thus we have a sympathetic phenomenon depending on direct and specific 
powers of the agent, and another arising out of the state of the organs, both of 
vhich are capable of characterizing the form of epidemic disease. These phe- 
nomena are well known, and are admitted, I believe, among the best settled 
principles of pathology and therapeutics. Now, the sympathies or secondary 
affections in dengue, are obviously attributable to one or the other, and, it is 
possible, to both. They were produced by primary irritation of the same parts 
precisely, which, in other seasons, have given birth to yellow or bilious fever. 
But whether through the first or the last, or through both principles, it would 
be temerity, perhaps, to decide positively. At the same time, then, that I 
maintain the certainly of the pathological origin, and the difficulty of assigning 
any reason beyond analogy for its results, I am disposed to think that the most 
probable cause of those results was permanent predisposition of a novel charac- 
ter, and not a specific poison. I am strengthened in this impression, by the fact 
of the constant successions of cutaneous disease, to which we have been subject 
for some time, witliout regard to varieties of season or temperature. 

" The convalescence from dengue furnished additional facts in confirn^ation of 
the opinion that it was radically a g-astro-enteritis. In many instances this was 



American Intelligence, 27i 

interrupted by transient relapses of pain at the joints, with or without fever. 
They proceeded from exposures to inclement weather, or from wrong* diet, but 
generally from the latter — as luxurious compositions, wine, porter, acids — which 
the stomach could not digest, or which produced unwholesome degrees of ex- 
citement. I knew a person who could not indulge in the use of oranges or 
limes, and another who could not take a few glasses of Madeira wine, without 
incurring, on the succeeding day, indisposition, with foul tongue, and repetition 
of rheumatic pain. I knew, also, an old lady who suffered long from numerous 
relapses of a slight nature, in consequence of persisting to introduce into her 
stomach dainty articles of food — resorting to spices and pepper for condiment, 
and using ardent drinks for sudorific effects. By my advice she abstained from 
this course, took a few doses of castor oil, and soon recovered from every rem- 
nant of disease. During my own convalescence, a few ounces of wine, or any 
rich species of diet not promptly digestible, irritated the bowels, and immedi- 
ately occasioned a return of stiffness, pain and feverish sensations. These recur- 
rences of disease at the exterior, by obvious invitation of the mucous membrane 
from direct applications of stimulating substances to its surface, appear to me 
to place the pathology which I am defending, in a still more lucid point of view. 

•' I have said that dengue was essentially the breakbone which we had expe- 
rienced in 1826, and also in 1827. The analogy was so striking, that I do not 
believe we should have called it by another name, if it had not appeared in 
some other southern cities at the same time. The points of resemblance were, 
the universality of both diseases, the same gradual progress by which the en- 
tire population became involved, excruciating pain of the limbs and loins, the 
same species of cutaneous inflammation, singular violence, and short duration of 
both, their common characteristic of forming but one paroxysm, red injection 
of the vessels of the conjunctiva, uniform recovery. On the other hand, the 
dissimilitude consisted in longer continuance of pain in dengue than breakbone, 
more exclusive confinement of pain to the joints, less debility, and lesstedicus- 
ness of convalescence. The differences were few, in comparison with the re- 
semblances, and will be considered as unimportant. These may have arisen 
from slight variations in the circumstances of climate, in the same manner as 
trivial discrepancies sometimes occur between bilious endemics of different au- 
tumns, or as they take place at different epochs between any epidemics what- 
ever, that are unquestionably the same. 

** During the first stage of breakbone, it assumed so perfectly the aspect of 
yellow fever, that in 1827, Avhen cases of each were occurring at the same pe- 
riod, it was difficult or impossible, as already observed, to distinguish them. 
Both presented the red suffusion of the conjunctiva, and the red hps; and con- 
sisted generally *of one paroxysm only. The degree of pain incident to the 
former was commonly greater, but the difference did not invariably happen; the 
rest of the symptoms accorded in a manner curious and surprising. You could 
trace the career of two contemporary cases from commencement to termina- 
tion. At first the correspondence would be complete, and each would seem to 
be pr'dceeding to similar conclusions, when, abruptly, and without perceptible 
cause, the one appeared to sweep the disturbances it had excited into the sto- 
mach, and ended in black vomit, while the other precipitated itself upon the 
skin, and eventuated in a fugitive inflammation. Both breakbone and black 
vomit were indeed in the original essentially the same morbid affection, for both 
were equally gastro-enterites. The former differed in its event from the latter, 
because the critical effort of the skin and limbs interposed, and afforded effec- 
tual relief to the stomach. Without that interposition, we have the strongest 
reason to think that the progress and catastrophe would have been the same. 

"In the course of this season, also, cases of breakbone and black vomit pre- 
sented the singular circumstance of being mixed with a much greater propor- 
tion of remittents and intermittents, but particularly of the latter. These were 
numerous and generally distributed, while those were sparse and preferred the 
locality of certain wards. This diversity of forms, evidently arising from a com- 



272 QUARTERLY PERISCOPU, 

mon miasma, is very remarkable, no matter how it be accounted for. The black 
vomit and breakbone might have amounted to the number of fifty cases. No 
native I believe died of the former, thoug-h several had been residents of long 
standing-, or had passed throug-h the great epidemics of former years. I have 
recorded among my notes the case of a respectable mechanic, who had resided 
permanently in the city for a length of time. He had been occupied in super- 
intending the erection of a saw-mill upon the neighbouring low grounds, where 
it was his custom to spend the day only. If he had contracted bihous fever of 
a violent grade, it would not have been matter of surprise, as he was subject to 
the precise causes which produce it. But he sickened with the worst degree 
of yellow fever, and died of black vomit, a form of disease peculiar to the citj', 
and never generated by marsh effluvia alone, as far as observations made have 
extended. He imbibed the city disease, against which he might have been ex- 
pected to be acclimated, and escaped that which pertains to the country, to 
which defect of habit ought to have subjected him. No one imagined, nor was 
there ground for suspecting, that either black vomit or breakbone had origi- 
nated in contagion. Individuals were affected, whose modes of life were such 
as rendered this impossible. I attended one lady with yellow fever, who had 
been so constantly confined to her apartment that she could not have contract- 
ed it from another. I attended another lady who was a native, but had been an 
absentee for some years? she was attacked with breakbone, although scrupu- 
lously secluded for security against the prevalent diseases, and could not have 
been infected by personal communication. There was a family of my friends, 
in which several cases, differing in character, occurred. The gentleman was 
fiirst taken with chill, and subsequent violent hot fit. During the paroxysm he 
swallowed an excessive dose of oil, which, together with the disease, consider- 
ably reduced him. Nevertheless, a total suspension of fever took place, and he 
was promptly cured by frequent administrations of sulph- quinse in 3 gr. doses. 
This case would probably have assumed the intermittent type if it had been 
allowed to continue. At the same epoch, a woman, who, in consequence of 
disordered imagination, had not gone into the street for many weeks, was taken, 
while labouring under fever, from a neighbouring house, and introduced into 
this family, to be properly nursed. She complained of pain about the abdomen, 
particularly in the region of the uterus or bladder, of tenderness at the epigas- 
trium, when pressed upon by the hand; and she seemed to be very nervous. 
Soon after, the eyes became red, occasional vomiting took place, and some 
coffee-coloured flocculi were discharged. I considered this patient as affected 
with desperate yellow fever, and her case beyond remedy; unexpectedly, how- 
ever, she got well under a treatment with sulph. quin. in exorbitant doses. 
Before this woman had entirely recovered, the black girl who officiated as her 
nurse was seized with the excruciating- pain, single intense paroxysm, and ac- 
quired the injected eye of breakbone fever. By administering some aperient 
medicine, she recovered completely, but was extremely prostrated. The lady 
of the family now sickened with fever; the symptoms were such as accompany 
a common febrile attack, except that the vessels of the conjunctiva werd^lled 
with red blood. She suffered with excessive tenderness of stomach, so that 
scarcely any thing she swallowed was retained. On the third day, the skin be- 
came deeply jaundiced, the pulse slow, as when black vomit has made its ap- 
pearance, and death ensued on the fourth day from the commencement: black 
matter was said to have been thrown up, but I did not see it, nor could I vouch 
for it. Immediately after the dissolution of this lady, an attendant black woman 
contracted fever, and although her case was longer, was divided into paroxysms, 
and she was more intensely ill, the symptoms exhibited were very similar to 
those presented in the instance of the black girl's above mentioned. About 
this period, also, the son of the deceased lady, a boy of five years, was taken 
with fever; the active symptoms soon subsided into that species of tranquillity 
which usually attends black vomiting; the eyes became red, and the bowels 
sensitive when pressed. Instead, however, of ejecting any black fluid from the 



American Intelligence. 273 

stomach, that organ remained entirely passive, and large quantities of grumous 
blood were discharged per anum. The discharge of blood continued for about 
a week, and the patient's health, although slowly, was finally re-established. 
After the restoration of this boy, as if the afflictions of the family were destined 
to be perpetual, a little girl, the sister, was assailed by fever of double tertian 
type, but she soon recovered under the operation of some mild evacuants. At a 
residence on the opposite side of the street, and distant a few yards only from 
that of which we have related the above particulars, another singular group of 
cases took place. A gentleman, his lady, and two servants, were successively 
seized with fever. The servants were affected with one long paroxysm, ac- 
companied by pains, which gradually wore off under the influence of castor 
oil. The lady was attacked with excruciating pain in the left hip, which con- 
tinued for some hours before the fever appeared. She then had a single hot fit 
of unusual duration, with pains in other parts of the body, together with inflamed 
eyes and eyelids, which were all concluded by a transitory eruption upon the 
skin. This was as true dengue as ever occurred in 1828. The gentleman was 
soon after taken with fever in the ordinary way, an intense hot fit followed the 
collapse, but there was no pain except in the head. The eyes were at first 
irritable and red, but afterwards, in conjunction with the skin, assumed a deep 
yellow hue. This case lasted four days without manifesting any appearance of 
periods. I consider it to have been yellow fever complete in every point but 
black vomit. The jaundice continued for three weeks after the extinction of 
fever, and probably constituted a critical revulsion, as the eruption had done in 
the previous case of the lady. Numerous other groups of intermittent, remit- 
tent and yellow fever, breakbone or dengue, took place during this season, 
which it would be needless to recount, but which were decisive of the common 
and local origin. As regards yellow fever, breakbone and dengue, the remote 
cause confined itself to the boundaries of the city proper. These began to pre- 
vail about the first of September, when north-east winds usually predominate; 
and terminated under the effect of frost. Not one case is known to have orig'- 
nated upon the plantations; and although some persons after having imbibea 
them went into the country, it is not ascertained that they propagated them in 
a single instance. These facts conclusively finish the argument, it appears to 
me, against the suspicions of contagion or importation. It is curious to observe 
the propensity of every community to attribute diseases of a novel or grave 
character to a foreign source, and to cast on others the misfortune of inhabiting 
the place of their birth. Some time since I was conversing with a gentleman 
from Cuba on the subject of dengue, and he informed me that it was supposed 
by the people of Havana to have been brought among them from the windward 
islands, and that they believed as little in its production there, as the citizens of 
Charleston appear to believe in its original production among them. 

The treatment applied to the epidemics of 1827 and 1828 by a majority of 
the physicians, was what we consider to be thoroughly sedative. Moderate 
evacuations with oil or Epsom salt, for the limited purpose of emptying the 
bowels and expelling unwholesome feculences, together with absence from 
irritating drink and food, constituted the prominent remedies for dengue. They 
assisted to consummate the critical act by reducing gastric and intestinal ex- 
citement; and by precluding reiterated inflammations of the mucous membrane, 
they removed the chronic pains which sometimes infected the joints. The pa- 
thology which has been sustained obviously dictated this method, and the prac- 
tice confirmed its correctness by the uniform success which attended it. Those 
who adopted it promptly recovered from the acute attack, and those who per- 
sisted in its use while any sequelae existed, were expeditiously and certainly 
relieved. At least two-thirds of breakbone^ as well as denguCy were thus manag'ed, 
and as far as I am informed, were all terminated well, and speedily as could 
have been reasonably desired. This course promoted the production of the 
secondary sympathy of the skin and extremities, by preventing a greater degree 
of inflammation in the mucous surface than was compatible with its transposi- 

24* 



274 QUARTERLY PERISCOPE. 

tion. For it is now a principle well understood, that in the exanthemata, there 
is a certain point of excitement, which comports with the translation of the dis- 
ease from the interior to the exterior, and that every augmentation or reduction 
of it erects an obstacle to this result. 

Philadelphia Medical Society. — The annual oration this year was delivered by 
Benjamin H. Coates, M. D. one of the Corresponding Secretaries of the So- 
ciety. The subject chosen by the orator was the certainty of medicine, which 
he treated with his usual ability. 

Charge Addressed to the Graduates in Medicine^ at the Commencement of the 
Medical Department of the Columbian College, D. C. By Thomas P. Jones, M. D. 
Dean of the Medical Faculty. — We have read with much pleasure this interest- 
ing discourse — it is appropriate to the occasion, and the monitions which the 
author offers are wholesome and judicious. 

Coxe^s American Dispensatory^ eighth edition, has just been published by 
Messrs. Caret & Lea. 

Horner's General and Special Anatomy. — Messrs. Carey 8c Lea have just pub- 
lished a new edition of this valuable work. 

Macculloch on Remittent and Intermittent Diseases. — The cost of English works 
are generally so high, as to prevent their general circulation in this country; 
the price of the English edition of the work at the head of this notice is twelve 
dollars. As we believe that Dr. Macculloch's essay contains many original and 
valuable views, we congratulate the profession that it is now placed within thei? 
reach, having been republished at a moderate price, by Messrs. Caret 8c Lea. 

Memoir on the Treatment of Venereal Diseases without Mercury, employed ai 
Val-de- Grace. By H. M. J. Desruelles. — No work on syphilis has appeared 
in this country, au courant, with the present state of knowledge in relation to 
that disease; it affords us pleasure therefore, to announce that a translation of the 
memoir of M. Desruelles will shortly appear. This memoir has been, we think, 
justly lauded in the French journals; it is rich in personj^l observations, and 
eminently practical. 

The author has had very extensive experience during a long period in the 
Military Hospital of Val-de-Grace, and the result of his observations are entitled 
to every confidence. 

Hennen's Military Surgery is in the press and will be shortly published by- 
Messrs. Carey 8c Lea. Our esteemed cotemporary, the Editor of the London 
Medical and Surgical Journal, observes, "it is a work of supererogation for us 
to eulogize Dr. Hennen's Mihtary Surgery; there can be no second opinion on 
its merits," a sentiment in which we fully coincide. 



NECROLOGY. 

With deep regret we have the melancholy task of recording the death of one 
of the most esteemed, active, and able collaborators of this work, John D. 
GoDMAN-, M. D. On the 17th of April he terminated his earthly career, in the 
thirty -fourth year of his age, a victim to pulmonary consumption, brought on 
by too zealous application in the pursuit of science, and from exei-tions in the 
discharge of professional duties, too arduous for the strength of his corporeal 
frame. 

Thus has perished the estimable and gifted Godman, in the commencement 



American Intelligence, 275 

of a career which his capabilities and mental energies promised to have been of 
the most brilliant character, conferring by his labours, on society the highest be- 
nefits, and gathering to himself a grateful and unfading renown. His death is a 
loss to the medical literature and science of our country, that will long be felt, 
and will not be easily replaced. 

He has perished in a noble cause. But how unjust is society, how little it 
appreciates its true advantages, how unequal its estimate of useful services. 
Had Godman fallen by a foeman's hand on the field of carnage, the butcher of 
his race in a quarrel of sordid interests, he would have passed from the world 
shrouded with its glories, mausoleums would have been erected to perpetuate 
his fame, eulogy have poured forth its pompous harangues, poetry lavished its 
gorgeous decorations to blazon his memory, and a nation's coffers been opened 
to protect the widow from want and the orphan from desolation. 

He has died a sacrifice to the best interests of society and the permanent 
welfare of mankind — the advancement of knowledge, the progress of science, 
the refinement of humanity, and the melioration of the sufferings of human 
nature. The world looks coldly on, the tear of the philanthropist and friend 
in silence bedews his remains, the philosopher in retirement turns from his me- 
ditations to sorrow for his loss, and the widow and the orphan must look for 
their consolation and support, to the sad remembrance of his virtues. 

We hope in our next number to give a biographical memoir of our lamented 
colleague. 

It is with great regret that we have learned of the death of Stephek Elliott, 
Esq. late Professor of Natural History and Botany in the Medical College of 
South Carolina. ISIr. E. was an ardent cultivator of natural history, and one of 
the best botanists in our country. 

At a meeting of the Faculty of the Medical College of South Carolina, held 
on the 31st of March, on the occasion of the sudden and lamented death of Pro- 
fessor Elliott, the following resolutions were adopted: — 

Resolved^ That the Faculty of the Medical College of South Carolina deplore 
with profound regret the death of their much respected colleague, Stephen El- 
liott, late Professor of Botany and Natural History— that they regard his loss as 
an event calculated deeply to affect the interests of science and literature in our 
community, now deprived of a zealous and successful cultivator of learning in 
many of its most important departments. 

That an endeavour be made to procure a bust of our late colleague, to be 
placed in some conspicuous situation within our college edifice; and that the 
dean be authorized to set apart for this purpose any necessary amount from the 
treasury. 

That they offer to his afflicted family, in this melancholy bereavement, the 
expression of their heartfelt sympathies. 

Resolved further. That as the highest inducement to a faithful and unwavering 
performance of the several duties of social life, which can be offered to the 
young and ardent, is to be found in the reverence paid to the memory of the 
talented, the useful, and the virtuous, after death, they propose to the Literary 
and Philosophical Society of South Carolina, of which their lamented colleague 
was a prominent member, to unite in taking such measures as shall be deemed 
most impressive and suitable to evince their high regard for the deceased, and 
their sincere sorrow for his loss. With this view they suggest that a fit person 
be selected to deliver, as early as may be, a funeral oration, or eulogy, in me- 
mory of the departed, and that sufficient funds be forthwith provided for the 
erection of a monument, which shall record, however imperfectly, his worth, 
and our esteem. 

Died, on the 9th of September last. Dr. Josiah Goodhue, President of the 
Berkshire Medical Institution. Dr. Goodhue was born at Dunstable, Middlesex 
county, Massachusetts, January 17, 1759. He early devoted himself to study, 



276 QUARTERLY PERISCOPE. 

and entered Harvard University about the commencement of our revolutionary 
strug-g-le, where he remained until the disturbances of the revolution caused the 
colleg-iate exercises to be suspended, when he returned home, and soon after- 
wards commenced the study of medicine with Dr. Kittredg-e of Tewksbur}', 
with whom he continued two years, the usual period of medical pupilage at 
that time. He commenced practice at the ag-e of twenty, at Putney, Vei-mont, 
where his parents then resided; and the fame of his preceptor, and a success- 
ful operation of minor importance, soon Introduced him into business. He now 
beg-an to lay the foundation of his future usefulness. The standard of medical 
education was at that time very low; his preceptor's library is said to have con- 
sisted of not more than half a dozen volumes, and Dr. Goodhue feeling many 
embarrassments from the want of theoretical knowledge^ determined to procure 
and study all the latest and best works, a course which he pursued to the close 
of his life. His industry soon procured him very extensive practice, both me- 
dical and surgical. His first capital operation, that of amputation of the leg-, he 
performed without ever having seen it done before, and guided only by his 
books, and this was the case with most of his succeeding operations. 

In the year 1800, the faculty of Dartmouth college conferred on him the 
honorary degree of M. D. In 1803, he removed to Chester, Vermont, where 
he remained, enjoying" the unlimited confidence of his patrons and of his pro- 
fessional brethren, till 1816, when beginning to feel the infirmities of age from 
excessive professional duty, and wishing to curtail his business, he changed his 
residence to Hadley, Massachusetts, where he continued to practice until com- 
pelled to relinquish it by declining health. In the year 1823, he was appointed 
President of the Berkshire Medical Institution, an office which he held till his 
death. 

We are indebted for the above particulars of the life of Dr. Goodhue, to an 
interesting biographical memoir, by S. W. Williams, M. D. Professor of Medi- 
cal Jurisprudence in the Berkshire Medical Institution. 



QUARTERLY 
MEDICAI. ADVERTISER. 



IN consequence of the extended circulation of the American Jourkal oe 
THE Medical Scieitces, the Proprietors intend, in comphance with the wishes 
of many of their Friends, to increase the facihties for advertising, hitherto pos- 
sessed by it. For this purpose, a Sheet of Advertisements will be prefixed to the 
succeeding Numbers of the Journal. All Booksellers, Medical Gentlemen, and 
others desirous of taking- advantage of this mode of announcement, will please 
address their Advertisements to Carey & Lea, Philadelphia, by the 10th day 
of the month preceding that of the publication of the Journal, viz. on 10th 
July, 10th October, 10th January, and 10th April. 



TERMS. 



For one page 
Half a page or less 
Philadelphia^ January 20, 1830. 



Six dollars. 
Three dollars. 



UNIVERSITY OF PENNSYLVANIA. 

At a Medical Commencement held March Mth, 1830, in the Musical 
Fund Hall, Locust street, the Degree of Doctor of Medicine was 



conferred upon the following Gentlemen. 



Names. States. 

A. 

Samuel Abernethy, Penns. 

Alfred Anderson, S. C. 

Abram Maury Allen, Va. 

John W. Anderson, Md. 
Hugh Horner Abernethy, Penns. 

Richard D. Arnold, Geo. 

Levin H. Adams, Del. 

B. 

Thomas M. Boyle, Va. 

Randolph Brearley, N. J. 

Daniel J. Bruner, Penns. 

Robert P. Brooke, Va. 

William G. Britton, Va. 

Bennet A. Bouton, Penns. 

Thomas D. Brown, Va. 

John Foulk Bullick, Penns. 
Patrick H. W. Bronaugh, Va. 

Armistead F. Brackin, N. C. 

Thomas Barbour, Va. 

Joseph Baldwin, Penns. 

Charles H. Black, Del. 

Horace M. Belt, Va. 

C. 

Cyprian Cross, N. C. 



Subject op Essay. 



Traumatic Hsemorrhage. 

Neuralgia. 

Injuries of the Head. 

Dropsy. 

Rupture of the Uterus. 

Asthenia. 

Catarrh. 

Amenorrhcea. 
Dysentery. 
Asthma. 
Typhus Fever. 
Peritonitis. 
Croup. 

Pneumonia Biliosa. 
Stricture of Urethra. 
Paralysis. 
Cholera Infantum. 
Acute Dysentery. 
Haemoptysis. 
Bronchitis Acuta. 
Venesection in Fever, 

Pleuritis. 



Quarterly Medical Advertiser. 



Jonathan Clark, 


Penns. 


Variola Vaccina, 


James S. Carraway, 


Miss. 


Puerperal Convulsions. 


Jesse Carter, 


N. C. 


Mania a Potu. 


Felix G. Callaway, 


Geo. 


Inverted Toe Nail. 


Augustus H. Cenas, 


Louis. 


Colitis. 


William M. Cross, 


Va. 


Regimen. 


"William Cunningham, 


Va. 


Acute Dysentery. 


John F. Charles, 


Penns. 


Amenorrhcea. 


Joseph Carson, 
D. 
Eobert M. Dunbar, 


Penns. 


Animal Temperature. 


Va. 


Variola. 


Alex. Franklin Dulin, 


Va. 


Peritonitis Puerperalis. 


William R. Derickson, 

E. 
Benjamin Rush Erwin, 


Del. 


Small-Pox. 


N. J. 


Secale Cornutum. 


John R. Edmonds, 

F. 
Joseph W. Farnum, 


Va. 


Acute Hepatitis. 


R. L 


Verminous Affections. 


George Fitzgerald, 


Va. 


Pleuritis Acuta. 


Henry M. Fuller, 


S. C. 


Arthritis. 


George F. Fort, 


N.J. 


Hydro- Arachnitis Infaiiium, 


James Burette Ford, 


Va. 


Cholera Infantum. 


John F. Fauntleroy, 

G. 
Richard Garland, 


Va. 


Hydrocephalus. 


Va. 


Spontaneous Hemorrhage. 


Thomas H. Green, 


Penns. 


Hereditary Diseases. 


William W. Gerhard, 


Penns. 


Endermic Applications. 


Selah Gulick, 


N.J. 


Miasmata. 


Robert M. Garrett, 


Va. 


Capillary Vessels. 


Michael F. Groves, 


Penns. 


Hernia. 


William A. Gray, 


Va. 


Dysentery. 


Lewis M. George, 


Va. 


Lithotomy. 


John R. Garnett, 


Va. 


Cynanche Trachealis. 


Ezra Gildersleeve, 


Penns. 


Secondary Causes of Action in the Hu- 
man System. 
Typhus Fever. 


Lemuel Gustlne, 
H. 
Robert H. Harrison, 


Penns. 


Va. 


Active Hsemoptysis. 


John P. Harrison, 


Va. 


Bilious Fever. 


Samuel R. Haywood, 


N. C. 


Conduct of the Practitioner during La- 
hour. 
Suspended Respiration. 


Thomas Hun, 


N. Y. 


Edward B. Harris, 


Alaba. 


Menstruation. 


Alexander Hall, 


N. C. 


Structure and Functions of the Mucous 
Memhranes. 


Edward Hallowell, 

J. 
Geo. Jacob Janeway, 


Penns. 


Pathology of Local Inflammation. 


Penns. 


Peritonitis. 


William Jones, 


Penns. 


Haemoptysis. 


Robert H. Jones, 


Penns. 


Rubeola. 


Robert B. James, 

K. 
William Keith, 


s. C. 


Enteritis. 


Penns. 


Intermittent Fever. 


William H. Klapp, 


Penns. 


Cholera Infantum. 


I^Iarshall M. Keith, 

L. 
Ezekiel Lamar, 


Va. 


Trachiiis. 


Geo. 


Bilious Remittent of Southern States. 


Hartwell H. Lewis, 


Va. 


Acute Peritonitis. 



Quarterly Medical Advertiser. 



Thomas Lewis, Va. 

James H. Lufborough, D. C. 

Thomas Lee, Jr. N. J. 

John S. Landes, Penns. 

Evan G. Lester, Penns. 

James B. Living-ston, N. Y. 

M. 

James D. Mead, N. Y. 

Frederick Martin, Penns. 

Thomas Mathias, Penns. 

Charles H. Martin, Penns. 

Francis Mallory, Va. 
Alexander F. M*Kinney, Tenn. 

N. 

George Norris, Penns. 

Thomas H. Nelson, Va. 

P. 

Josiah H. Phelps, Vermont. 

Walter R. Puckett, Va. 

Edmund P. Pollard, Md. 

James R. S. Purnell, Md. 

James T. Persons, Geo. 

Thomas Payne, Va. 

Chillian Palmer, N. C 

William J. Pendleton, Va. 

Jeffrey D. Palmer, Va. 

R. 

David John Rogers, Penns. 
Edward Florens Rivinus, Penns. 



Joseph Rittenhouse, Penns. 

Robert C. Randolph, Va. 

Lewis Roper, Penns. 

Zachariah Reed, N, J. 

James H. Ragan, Geo. 

Nathaniel M. Roan, N. C. 
Wm. S. W. Ruschenberger, U. S.Navy. 

S. 
George F. H. Strawbridge, Penns. 

Wilson C. Swann, D. C. 

Albert H. Shepherd, Geo. 

Daniel B. Searcy, Geo. 

William Selden, Va. 

Charles P. Street, Va. 

James \l. Smith, Penns. 

Thomas Stewardson, Jr. Penns. 

Albert Snead, Va. 

Boiling Winslow Stark, Va. 

T. 

Joseph W. Taylor, Penns. 

Edward T. Taylor, Va. 

William B. Todd, Va. 

John F. Townsend, N. Y. 

V. 

John Van Buskirk, Jr. Penns. 

W. 

John W. Waller, Va. 



Trachitis* 

Gastritis. 

Datura Stramonium. 

Acute Gastritis. 

Bilious Colic. 

Cynanche Trachealis. 

Dysentery. 

Diaphoretics. 

JRupture of Uterus. 

Epilepsy. 

Causes of Yellow Fever. 

Origin and Progress of Medicine, 

Varioloid and Vaccine Diseases. 
Concussion of the Brain. 

Croup. 

Cholera Infantum. 

Haematemesis. 

Inflammatory Dysentery. 

Gastritis Acuta. 

Cynanche Trachealis. 

Autumnal Fever. 

Ophthalmia. 

Diet in Disease and Convalescence. 

Epilepsy. 

Operation of Physical Causes upon the 

Constitutiony Healthy and Diseases of 

Man. 
Cholera Infantum. 
Hepatitis. 

Physiology and Pathology of the Teeth, 
Gonorrhoea Virulenta. 
Syphilis. 

Idiopathic Hydrothorax. 
Diseases of the Liver. 

A Peculiar Spasmodic Affection. 

01. Terebinth. 

Gastro-Enteritis. 

Bilious Fever. 

Bilious Fever. 

Endermic Applications. ' 

Ruhenla. 

Digcsiion. 

Erysipelas Phkgmonodes. 

Puerperal Fever. 

Opium. 

Sayiguineous Depletion. 
Bilious Remittent Fever. 
Dyspepsia. 

Dysentery. 

Strictures of Urethra. 



Quarterly Medical Advertiser, 



John James Wharton, 


Va. 


Erysipelas. 


Thomas Wilson, 


Penns. 


Hydrops Mdominis. 


George White, 


N.J. 


Bilious Remittent Fever. 


Conway D. Whittle, 


Va. 


Acute Hepatitis. 


Thomas Edward Wilson, 


Ky. 


Opium. 


James C. Workman, 


Penns. 


Dysentery. 


George Wood, 
Y. 
Thomas J. Yarrow, 


Va. 


Acute Peritonitis. ^ 


N.J. 


Icterus. 


ITotal, 125.] 




W. E. HORNER, M. D. D 



MEDICAL COLLEGE OF SOUTH CAROLINA. 

Officers of the Medical College of South Carolina. 
JOHN EDWARDS HOLBROOK, M. D. Professor of Anatomy. 
JAMES RAMSAY, Professor of Surgery. 
SAMUEL HENRY DICKSON, Professor of the Institutes and Practice of 

Medicine. 
HENRY R. FROST, Professor of Materia Medica. 
THOMAS G. PRIOLEAU, Professor of Obstetrics and Diseases of Women and 

Children. 
EDMUND RAVINEL, Professor of Chemistry and Pharmacy, 
STEPHEN ELLIOTT, Professor of Natural History and Botany. 
JOHN WAGNER, Professor of Pathological and Surgical Anatomy. 
JOHN WAGNER, Demonstrator of Anatomy. 

HENRY R. FROST, Dean of the Faculty. 
GRADUATES IN 1830. 



Enoch Agnew, 
William S. Burgess, 
A. L. Barron,* 
Austin B. Brown, 
William D. Boyd, 
Charles B. Carter, 
Frankhn W. Cheney, 
Henry S. Cook, 
John D. Caldwell, 
A. S. Clifton, 
Isaac B. Cannon, 
Benjamin F. Dozier, 
Hutchinson Dent, 
Thomas S. Denny, 
Timothy K. I. Dargan, 
John Dickson,| 
Isaac F. Eves, 
Richard C. Fowke, 
John W. Gardner, 
William M. Grigsby, 
John K. Gary, 



KESIDElSrCE. 

Abbeville Dt. 
Williamsburg Dt. 
Charleston, 
Barnwell Dt. 
Chester Dt. 
Augusta, Geo. 
Georgia, 
Camden, S. C. 
Sumpter Dt. 
Columbia, 
Newbury Dt. 
Williamsburg Dt. 
Augusta, Geo. 
Charleston, 
Darhiigton Dt. 
Charleston, 
North Carolina, 
Barnwell Dt. 
Augusta, Geo. 
Alabama, 
Newbury Dt. 



SUBJECTS OF ESSAY. 

Retention of the Catamenia. 

Retrocedent Gout. 

Irritation. 

Tetanus. 

Hydrops. 

Catamenia. 

Cathartics. 

Dysentery. 

Hydrophobia. 

Inflammation, 

Dyspepsia. 

Thoracic Wounds, 

Anat. and Phys. Portal System. 

Puerperal Fever. 

Erysipelas. 

Nervous Head-ache. 

Vicissitudes of Temperature. 

Rhus Vernix. 

Fractures. 

Bilious Fever. 



* To this gentleman was awarded the premium offered by the faculty for tlie best Dissertation in 
the English language. 

t A premium of twenty dollars having been offered by the Medical Society of South Carolina, for 
tlie best Dissertations in the Greek and Latin languages, the president of the society announced that 
the Thesis of this gentleman in the Greek language had been approved by a committee of literary 
gentlemen, and tjie premium was accordingly conferred. 



Quarterly Medical Advertiser, 



Henry B. Holland, 
James P. Jervey,* 
Edward W. Jones, 
Thomas Lee, 
Thomas L. Lyles, 
Georg-e A. C. M'Whorter, 
"William S. Mobley, 
Abner Manley, 
William M'Queen, 
John M*Lemore, 
William D. Marsh, 
John 'Nicholson, 
Richard North, 
Henry T. Nicholes, 
Thomas L. Og"ier, 
Robert Oswald, 
WiUiam Pinckney, 
Andrew Pulliam, 
John Rhodes, 
E. M. Robertson, 
Presley B. Ruff, 
William M. Reid, 
Benjamin Sweat, 
Samuel Sample, 
A. S. Starr, 
R. L. Tag-g-art, 
Henry L. Theus, 
James W. Thompson, 
William T. Wrag-g-, 
Andrew Wicker, 
Eldridge C Williamson, 
Morton Waring-, 
Charles Wilson, 
Philip Yonge, 



Savannah, Geo. 

Charleston, 

Georgia, 

Charleston, 

Newbury Dt. 

Aug-usta, Geo. 

Edgefield, 

Georg"ia, 

Chesterfield, 

Richland Dt. 

Alabama, 

Edg-efield Dt. 

Charleston, 

Coosawhatchie, 

Charleston, 

Beaufort, 

Walterborough, 

Abbeville Dt. 

Beaufort, 

Augusta, 

Newbury Dt. 

Grahamville, 
Abbeville Dt. 
York Dt. 
Abbeville Dt. 
Sumpter Dt. 
Spartanburg- Dt. 
Charleston, 
Columbia, 
Georgia, 
Charleston, 
Augusta, Geo. 
Florida, 

Total, 55 



Melancholia. 
Be. Fehre Intermitiente, 
Amenorrhoea. 
Yellow Fever. 
Bilious Remittent Fever, 
Malaria. 
Gastritis. 

Circulation of the Blood. 
Haemorrhage. 
Epilepsy. 

Injuries of the Head. 
Hydrophobia. 
Yellow Fever. 
Dysentery. 

Anal, and Phys. Eye. 
Mania a Potu. 
Contagion. 
Dyspepsia. 

Podophyllum Peltatum. 
Bilious Remittent Fever. 
Hepatitis. 
Blood-letting. 
Tetanus. 
Dysentery. 
Cholera Morbus. 
Mercury. 
Apoplexy. 

Ulcers. 

Malaria. 

Influenza. 

Typhus Gravior. 

Diseases of Warren County, Geo. 

Rheumatism. 



The class in attendance upon the lectures the last session, amounted to one 
hundred and sixty students, from the states of South Carolina, North Carolina, 
Georgia, Alabama, and the Territory of PUorida. 



PUBLIC VACCINE INSTITUTION OF PHILADELPHIA. 

The Select and Common Councils of the City of Philadelphia, having so alter- 
ed the ordinance providing for the gratuitous vaccination of the poor of said 
city, as to make it the duty of four individuals; and the subscribers havin-g been 
appointed to the performance of the above duties, would respectfully inform the 
Medical Profession throughout the United States, that it is their intention to 
keep a constant supply of genuine fresh vaccine virus, which they will supply 
on receiving a small remuneration for the extra trouble it will ocicasion. Appli- 
cations, (post paid,) enclosing three dollars, addressed to either of the subscui- 
bers, will be promptly attended to. 

DAVID C. SKERRETT, M. D. GEORGE SPACEMAN, M. D. 

No. 155, South Tenth street. Twelfth street, one door below Race. 

JOSEPH PANCOAST, M. D. AMOS PENNEBAKER, 
No. 103, Walnut street. ' No. 91, North Fourth street. 



* A premium of twenty dollai-s-was conferred on this g;entleraan for the best Essay in the Latia 
larij^uage. 



No. XL— May, 1830. 



25 



Quarterly Medical Advertiser. 



MEDICAL INSTITUTE OF PHILADELPHIA. 

The Summer Course of Lectures will begin on Monday the 5th day of 
April, and end on the Saturday preceding the first Monday of November. The 
month of August is a vacation. 

NATHANIEL CHAPMAN, M. D. WM. E. HORNER, M.D. 

On the Practice of Medicine. On Anatomy. 

WM. P. DEWEES, M. D. JNO. K. MITCHELL, M. D. 

On Midwifery. On Chemistry. 

THOS. HARRIS, M. D. JOHN BELL, M. D. 

SuRGEois" U. S. Nayt, On the Institutes of Medicine, 

On Operative Surgery. and Medical Jurisprudence. 

SAML. JACKSON, M. D. HUGH L. HODGE, M. D. 

On Materia Medica. On the Principles of Surgery. 

Philadelphia^ January 14, 1830, 



MEDICAL INSTRUCTION. 



The high responsibility incurred by medical practitioners, and more especially 
by those, who, in our extensive country, may locate themselves far from the 
facilities and advantages which large cities present, renders the education of 
gentlemen for this profession, a matter of the greatest importance to the com- 
munity. A growing sense of this has doubtless given rise to the increasing 
number of students who pass the summer months in this city, in order that their 
studies may continue uninterrupted throughout the year; in fact, the advantages 
resulting from a regular attendance upon public institutions, where surgical 
operations are frequently performed, and all forms of disease to be witnessed, 
and the opportunities and leisure required for consulting medical works, are 
only to be obtained in this way. 

Entertaining these views, and disposed to facilitate, by eveiy means in their 
power, the progress of students in medicine, the subscribers propose to give a 
summer course, to commence on the first Monday in April next, and to con- 
tinue until the last of October. During the winter session of the University of 
Pennsylvania, the several courses there delivered will be reviewed by examina- 
tions. 

W. GIBSON, M. D. Principles of Surgery. 
J. RANDOLPH, M. D. Operative Surgery. 
C. D. MEIGS, M. D. Midwifery, &c. 
B. H. COATES, M. D. Practice of Medicine. 
R. LA ROCHE, M. D. Institutes of Medicine. 

R. E. GRIFFITH, M. D. Materia Medica, Medical Jurisprudence, and Bo- 
tany. 
J. P. HOPKINS ON, M. D. .inatomy. 

The Class will have the privilege of attending the Lectures on Chemistry, by 
Professor BACHE, at the Frankhn Institute. 

Philadelphia, January Isf, 1830. 



THE 

AMERICAN JOURNAL 



OF THE 



MEDICAL SCIENCES. 



Art. I. Case of Fungus Haematodes. Bj Thomas Sewall, M. D. 
Professor of Anatomy and Physiology in the Columbian College, 
District of Columbia. 

J. HE following case of fungus haematodes, occurred in the practice 
of Dr. M'WiLLiAMs of this city, the same gentleman whose name I 
have introduced in a former communication published in this Jour- 
nal. By the courtesy of Dr. M 'Williams, I had an opportunity of 
examining the case and marking its progress during .the life of the 
patient, and was afterwards requested by him to make the post mor- 
tem examination, and draw up an account of its history. 

The subject of the case was a Miss W of this city, about 

twelve years old, healthy, active, and intelligent. 

In November, 1828, while in the enjoyment of her usual health, 
she was attacked with slight pain and lameness in the left thigh. On 
examination a hard tumour, the size of a walnut, was discovered on 
the inside of that thigh, situated one-third of the distance from the 
hip to the knee-joint. This was deep-seated and extremely obscure, 
being under the thickest part of the fascia lata, but by strong pres- 
sure it was found to be moveable and disconnected with the bone. 
From the time of the first examination of the case, the tumour con- 
tinued to increase rapidly in size, and was attended with an almost 
constant, heavy, obtuse pain, which was also extended to the knee 
and ankle-joints, accompanied with an uneasy sensation in the whole 
extremity, producing a frequent desire to extend the limb and to 
change its position. The pain was always more severe and constant 
in cloudy and damp weather^ but at other times would occasionally 
remit for six or eight hours together. At the end of six months, the 

No. XII.— August, 1830. 27 



302 Sewall's Case of Fungus Hdematodes. 

tumour had acquired such a size as to disfigure the limb and to pre- 
vent the patient standing or walking, and the pain was more severe, 
and accompanied with a sensation of great heat or burning. 

During the last eight months, all the symptoms became aggravat- 
ed. The tumour increased with greater rapidity than before — its sur- 
face became irregular, and exhibited a glossy appearance, interspers- 
ed with livid patches and superficial vessels greatly enlarged, and 
when handled presented in different parts, very unequal degrees of 
firmness, at some points appearing soft and yielding, as if suppura- 
tion had taken place; at others, imparting to the touch a sensation of 
almost cartilaginous hardness. 

Ten days before her death, a rupture of the tumour took place, ac- 
companied by a copious discharge of acrid foetid sanies, and continu- 
ed without at all impeding its growth. 

She died on the 22d of January, 1830, fourteen months from the 
commencement of the disease. 

It should be remarked, that during the continuance of the disease, 
till within two days of its termination, the appetite was good; large 
quantities of nutritious food were taken and digested without diffi- 
culty; but as the parents justly observed, all the aliment she receiv- 
ed seemed to be expended in the development of the disease, rather 
than in the nourishment of the body. 

The treatment of the case consisted principally in topical applica- 
tions; but these had not the slightest influence in arresting the pro- 
gress of the disease, or alleviating the sufferings of the patient. 

The morning after the death of the patient, the following examina- 
tion was made. 

The body was found in a state of great emaciation. The leg and 
foot of the diseased limb were oedematous and considerably swoln. 
The tumour, as to form, size, and colour, is accurately delineated in the 
accompanying drawing, PI. I. It involved the whole thigh, and ex- 
tended down over the knee-joint, measuring in length fifteen inches, 
in diameter twelve inches, and in circumference three feet. By a ho- 
rizontal section about one-third of the tumour was removed, by which 
its internal structure was clearly brought to view. On careful exa- 
mination it was found that every tissue which entered into the struc- 
ture of the thigh, had undergone an entire change in organization, 
and had assumed all the characters of the morbid growth, except the 
fascia lata, and this was greatly thickened. On the anterior part of the 
thigh a large cavity was found, containing about twenty-four ounces 
of fluid resembling olive oil, its walls thick and cartilaginous, with 
osseous depositions. On the posterior part of the thigh, corresponding 



Wright on the Warm Bath in Season Fever. 303 

with the cavity just described, was a hard tumour, several inches in 
diameter, apparently composed of condensed cellular substance, with 
cartilaginous structure and osseous matter. This, together with the 
cavity already mentioned, constituted about one-fourth of the tumour. 
The remaining three-fourths, resembled in colour and consistence, 
the medullary substance of the brain, irregularly intermingled with 
cortical matter. 

This mass was intersected by numerous membranous septa, form- 
ed probably originally of cellular substance. There were also nu- 
merous sinuses running in different directions, containing viscid sa- 
nies, and their walls formed of a dark-coloured membrane, apparently 
the inter-muscular fascia, much thickened. 

The shaft of the bone was also extensively diseased. It was en- 
larged, spongy, and flattened, and had many small spiculae project- 
ing from it. It was fractured about four inches from the head, which 
I was informed happened after death, in attempting to move the 
limb. The extremities of the bone were sound, and the structure of 
the hip and knee-joints not in the slightest degree changed by the dis- 
ease, although the tumour enveloped both. 

Washington^ />. C, May, 1830. 



Art. II. On the Use of the Warm Bath in Season Fever, commonly 
called " Bilious,'^ " Bilious Typhus,^' 8fc. Src. By Thomas H. 
Wright, M. D. Physician to the Baltimore Alms-house Infir- 
mary. 

W HILE those districts or localities in our vicinity, which are usu- 
ally the principal theatres of autumnal fevers, were less visited by 
those diseases last fall, than hitherto, the cases of fever from season 
causes, admitted into the wards of the Baltimore Alms-house, in the 
months of September, October, and November, 1829, were more nu- 
merous, and of more grave character, than in former years. This 
seeming inconsistency is susceptible of explanation, in the fact, that 
the great public works, now in active operation around us, (rail-roads, 
canals, and works of a more local character, but of considerable mag- 
nitude, all recently undertaken,) have called together and concen- 
trated in this neighbourhood, a new and large body of labourers of all 
classes, constitutions, and habits. Emigrants from Europe just land- 
ed on our shores, and full of the constitutional elements of febrile 
elaboration in a new climate— 'the mechanics of our towns and vil- 



304 Wright on the TVarm Bath in Season Fever. 

lages, accustomed to shelter from the weather — and the farmer from 
higher and healthier regions of the country, have all rushed together 
on the line of these public works, to encounter the vicissitudes of 
season, and all the evils of exposure, in situations hitherto avoided 
at one period of the year, as the peculiar theatres of pestilence and 
death.* But it is not alone exposure to the sun, and rains, and dews, 
and noisome exhalations of our sickly season, that rendered those 
works the fruitful sources of disease. Hard work, hot suns, chilling 
damps, &c. have done their part in producing febrile ferment; yet 
greater and more serious has been the preparative operation of other 
causes connected with the prosecution of those works, on the health 
of those engaged in them. Hard drinking, gross and unwholesome 
food, the foul hovels in which multitudes herded together at night, 
and the prevalence of licentiousness and debaucheries of every kind, 
these are the causes which rendered climate influences so sure, and 
their consequences so terrible, to the class of persons described, and 
which filled all the asylums of the homeless sick, in this community, 
with the subjects of season fever, in all its forms and complications. 
It is not the design of this communication to describe in detail the 
characters or treatment of the fever in question. The subject is intro- 
duced mainly for the purpose of submitting to the profession, the ge- 
neral result of a course of management, worthy of notice for its sim- 
plicity, and of value on that account, if at the same time, the evi- 
dence is satisfactory, that it was equally successful, with any other 
plan of treatment that could have been employed. To keep this ques- 
tion as much as possible free of all appearance of partial representa- 
tion, I have abstained from offering any opinions or inferences of my 
own on the subject, and have asked of the respectable young medical 
gentlemen who resided in the house, and personally carried on the 
detail of treatment, answers to certain queries, comprehending every 
thing important or illustrative in relation to the course pursued. A just 
confidence in the liberality of the profession, forbids the anticipation 
of any objection to the report of the class of students, on the ground 
that their answers may wear a complexion more of courtesy to my 
wishes, than of conviction on their own part. It is not from apprehen- 
sion of such objection, but from my own sense of propriety, I take 
occasion to remark, that when the queries were addressed to them, 
they were requested to frame their answers by the independent and 
unbiassed dictates of their personal experience and observation. To 

* The works referred to, traverse for the most part alluvial districts, and 
keep as much as possible the ravines of our inland rivers and streams. 



I 



Wright on the Warm Bath in Season Fever. 305 

another objection which might suggest itself, to even the most liberal 
and candid, in reference to those answers; namely, that coming from 
students of medicine, they want the sanction of age, experience, and 
capacity for discrimination. To such objection I may state, that the 
respondents are young gentlemen of talents, zeal, and discretion, 
worthy the science they cultivate; have been long — two and three 
years — engaged in the study of their profession; have been trained 
therein by able public teachers and private instructors; and are fami- 
liar with the opinions of books and men, on the pathology and treat- 
ment of the diseases, about which they offer the evidence of their 
own experience. 

A copy of the following queries was handed to each of the resident 
students of the Baltimore Alms-house. 

To R. J. THOMPsosr, Senior Student of the Baltimore Alms-house. 
Sir — Do me the favour to answer, as briefly, yet explicitly as possible, and 
entirely according- to your experience and belief, the following queries. 

T. H. WRIGHT. 
December 1st, 1829. 

1st. In the numerous cases of season fever, remittents, or the same, fallen 
into the continued type, which came into our wards during the past summer 
and fall, what single mean of treatment, seemed more than any other, to allay 
constitutional irritation, regulate temperature, quiet the tumult of the vascular 
system, tranquillize and comfort the patient, prepare for the beneficial effects 
of medicine, and thus predispose to convalescence ? 

2d. What manner of topical address did you find most efficient in abating" 
and extinguishing gastric, hepatic, and cephalic derangements, complicated in 
various forms and intensity, with the cases of constitutional (season) fever above 
mentioned? 

3d. What class or form of medicinal agents, appeared best to fulfil the indi- 
cation of quieting irritation in the gastric system, and as sedatives, or febrifuge 
means, promoting the gradual extinction of fever? 

4th. Of the cases of season fever, acute, congestive, typhoid, &c. with vari- 
ous complications, treated by you on the general plan indicated by the answers 
to the preceding questions, what proportion recovered? 

5th. Of those that recovered, what proportion were treated by mercury, or 
took mercury at all in any form ? 

6th. Of the cases of the fever in question, that were brought to us under full 
mercurial action, what influence did the constitutional impression of that agent 
seem to have exerted over the characteristic form of fever? 

7th. Did salivation in those cases, appear to have prepared the system for the 
solution of season fever; did those cases recover more promptly and perfectly, 
than others where mercury had not been taken? 

8th. Did you know of any instance of season fever, treated in our wards, 
where the warm bath, however frequently repeated, seemed to relax or depress 
dangerously, or produced any bad consequence.^ 

27* 



306 Wright on the JVarm Bath in Season Fever. 

Answers to the foregoing queries. By R. J. Thompson, Senior students 
To Quere 1st. — " The warm bath. 

2c?. — «* Liberal cupping-. 

3d. — " Mild febrifug-es, (aperients of neutral salts and magnesia^ 
and saline diaphoretic mixtures,) with acidulous and di- 
luent drinks exhibited ad libitum. 

4ih. — " Of fifteen decidedly marked cases, excluding many leas 
violent, three died. One of these was brought in mori- 
bund, another was deeply affected by icterus, the third 
was labouring under the low grade offerer, complicated 
with severe syphilitic disease. 

5th. — "I administered mercury to two cases only: one of those was 
mentioned above as being complicated with icterus. The 
other case appeared to be benefited by calomel, com- 
bined with other purgatives, and it was thus exhibited. 

6th. — " The ' mercurial action' appeared to have aggravated con- 
stitutional (febrile) irritation. 

7th. — " Salivation did not appear to have prepared the system for 
the solution of the season fever; and in the cases most 
vividly in my remembrance, it seemed to have rendered 
the cure more embarrassing. 

8th. — "I remember no such case; but on the contrary, believe I 
had reason always to felicitate myself upon its employ- 
ment. Its use was looked upon by all the resident stu- 
dents as highly necessary in our mode of treatment." 

Answers to the same. By A. F. Glasseli, Resident student. 
To Quere 1st. — *' The warm bath. 

2d. — " Cups and blisters, especially cups. 

3d. — "Diaphoretics, (with aperients, magnesia, Epsom salt, carbo 
ligni.) The alkaline salts in combination with the vege- 
table acids, generally in the form of the neutral mix- 
ture.* Acidulated drinks freely. 

4th. — " I treated eight severe cases with the remedies above indi- 
cated; seven of them recovered. 

3th. — " Not one of those who recovered took mercury in any form. I 
treated one patient with calomel, (in purgative and fe- 
brifuge doses,) — he died. 

6th. — " Mercurial impression protracted fever by augmenting the 
irritability of the system. 

7th. — " In no instance did the state of salivation appear to prepare 
for a favourable crisis, and always delayed recovery. 

Hth.—" The warm bath never, to my knowledge, produced dan- 
gerous debility. Some patients expressed the sensations 
produced by the bath as pleasurable, and requested its 
repetition. All felt relieved. 

* Lemon juice saturated with subcaj*onate of potash, sugar, water, and one grain of tartar emetic 
to fmir ounces of the mixture. 



Wright on the Warm Bath in Season Fever. 307 

Answers to the same. By A. L. Waknek, M. D. Resident student. 

To Quere 1st.—'' The warm bath. 

2d. — " Cupping" freely. 

3d. — "Carbon and carb. magnesia in purgative doses. Neutral 
mixture. Warm antimoniated lemonade. 

4;^._« Twenty-three cases of season fever, with gastric, and other 
complications, were treated by me, of which number 
three died. Two were delivered to us in nearly the dying 
state. 

5th.—" I did not administer mercury in any case. 

6th.—'' Aggravated the gastric symptoms, and rendered the con- 
dition of the patient more embarrassed and distressing. 

7th.—" The 'mercurial impression' appeared to postpone conva- 
lescence. 

8^^.— « The warm bath did not in any instance exhaust or depress 
injuriously. The patients uniformly expressed great im- 
provement in their feelings, and in many cases spontane- 
ously solicited its repetition." 

This paper is in no respect controversial. The whole design of 
the communication is expressed in the remark before made, "that it 
was intended to submit to the profession the result of a plan of treat- 
ment in some bad forms of fever, (from season causes,) valuable for 
its simplicity — if found to be successful." I have offered the best evi- 
dence on that head which the nature of the subject admits. 

Neither is it contemplated by this report to decry the employment 
of mercury in fevers, when the form of the disease, and the consti- 
tutional or pathological circumstances, are adapted to its use. I 
know, and appreciate highly, the value of the mean in question. In. 
inflammatory, or congesto-inflammatory diseases, when it is indi- 
cated to lower the grade of excitement, and avert or abolish embar- 
rassments of important structures, mercury, (in alliance with the 
lancet,) bj its relaxing dominion over the vascular functions, is ca- 
pable of accomplishing results, alike great and salutary. And again, 
when diseases of the class described, prolonged into a more chronic 
form, have impressed derangements of structure and office, the same 
agent is often capable gradually to dissolve such derangements, and 
restore both the part and the constitution to healthful reaction. But 
it is not, (I conceive,) in any of the forms of constitutional fever, 
characterized at once by weakness and tumult, or complicated with 
strong pathological developments — profound irritative disorder — in 
the vital and assimilating functions, that the decided relaxing im- 
pression of mercury is often either necessary or safe. Neither in 
such cases is the accumulative excitant influence of its continuous, 
though less full exhibition, likely to ensure a salutary crisis. 



308 Wright on the Warm Bath in Season Fever* 

The following communication from Doctor A. L. Warner, is ap- 
pended to show in general the character of the fever to which the 
preceding questions and answers apply: — 

" Alma-house, December 20th, 1829. 
" Doctor T. H. Wright, 

" Dear Sir — You requested me to furnish a statement of the number of cases 
treated for season fever in the house, during- the past summer and autumn, 
which I have neglected to this time, and must urge as apology, many interven- 
ing engagements. 

*« I have consulted the register of the house, as to the number, and by the 
assistance of memory, with my notes, I am enabled to descriminate the type. 

" The number of violent cases of the fever, termed by us, gastric fever, was 
thirty-Jive — of the less violent cases, eighteen — tog-ether, fifty-three. Eleven 
cases proved fatal, seven of which cannot be said to have been treated, as they 
were brought to the house scarcely alive. 

" The prominent feature of this disease was great irritation of the vascular, 
gastric, hepatic, enteritic, and encephalic systems. One of two conditions ap- 
pertained in all the urgent forms of this disease. Either great restlessness, or 
a total listlessness of all surrounding- objects, the patient in the latter case, lying 
on the back, eyes closed, and mouth wide open. 

^'Symptoms. — Supersensitiveness over the abdomen, particularly in the epi- 
gastrium; great nausea often; sometimes spontaneous vomitings.* Face flushed, 
(sometimes deep sallow,) and countenance anxious; respiration deep and slow, 
or short and hurried; tongue dry, and covered with a brown sordes, with deep 
red edges and tip; pulse, according- to the stage, full, large, slow, quick, indis- 
tinct, but never the firm corded pulse of true phlegmasia, establishing an im- 
portant pathological fact, that the tense corded pulse belongs to inflammatory 
derangement in the serous and fibrous tissues; the free soft pulse, (with fever,) 
to irritation in the mucous membranes; coma, more or less profound, was 
common; sometimes fretfulness of mind, and tossing from side to side. In se- 
veral cases, supersensitiveness all over the body, but particularly along the 
muscles on the posterior part of the neck. 

" Extensive spontaneous sloughingf was established in the early stage of the 
disease in some cases; in others, various cutaneous eruptions burst forth. t 

" Treatment. — Warm bath; mild purgatives, (carbon, and carb. magnesiae, 

* Deep green or blackish viscous matter, sometimes in large quantity, was 
passed by vomiting and stools, and found in the stomach and bowels of those 
dying of the fever. — W 

f Patches of surface inflammation, (erythemoid,) were very common in the 
fever described, often occurring to parts affected by pressure in lying, but fre- 
quently also in seats not influenced by pressure, the top of the shoulder, the 
forearm, and feet. These partial inflammations often ended in extensive, some- 
times deep sloughing, "erythema gangrenosum." — W. 

4: Erythematic and urticarious rashes, (lichen,) purpura, and blebs, or 
phlyctenje, often large, especially on the abdomen, and filled with bloody 
serum. — W. 



Wright on the Warm Bath in Season Fever. 309 

and Epsom salt, the former mainly,) neutral mixture, lemonade, and cups, (to 
the abdomen and head,) and if resorted to timely, was almost specific for gas- 
tric and constitutional irritation. I am aware you ascribe most importance to 
the warm bath, of the value of which I had daily proofs, but if restricted to any 
one prescription, I should select the carbonaceous and magnesian purgative, 
from the fact that many of the less violent cases, decidedly gastric, were prompt- 
ly relieved by this medicine, with acidulous drinks. As to the severity of this 
disease, there can be no doubt. I have been raised in a section of our city, 
where season fevers annually prevail with great violence, but never before saw 
the disease in so dreadful and terrific a form as in our wards, during the past fall. 
*' One point of the pathology of the disease, (frequently referred to by you, 
when indicating the phenomena of the cases,) is doubtless correct, to wit, spi- 
nal and cerebro-spinal developments, (irritation, congestion, and tendency to 
infiltration,) in the tunics of the medulla oblongata and spinalis. But that re- 
sult, (as you suggest,) attends the mature stage of die disease, and appears to 
be often a consequence of irritation propagated from other seats; the nervous 
system of the gastro-intestinal membrane. Daily recurrence to the symptoms 
in some of the most violent cases, suggests the fact of spinal embarrassment; 
for instance, embarrassed breathing was a promiment feature in the urgent forms, 
often at an early period. Spasms of the muscles of the neck, shoulders, and 
arms, was another common symptom. Hiccough* was another feature of the dis- 
ease, which some may regard as the consequence of gastric irritation, but I pre- 
sume it may indicate irritation at the root of the respiratory system of nerves, 
(par vagum, phrenic, and accessory,) for if attributable solely to the former 
cause, it should be an earlier and more uniform attendant. If expression is de- 
pendent on nervous influence, anxiety and disorder of countenance affords an- 
other argument. This, with jactitation, and unconscious shrugging of the 
shoulders, strongly import spinal irritation. 

* Hiccough. — A robust man was brought into the Infirmary, with the follow- 
ing symptoms. — Partial stupor, sensible when roused, but generally dozing, 
and indifferent to every thing. Face dark-red suffusion; tongue deep-flesh 
red, dry polish on the surface, could with difficulty, from dryness, be in part 
put out. Surface of the body dry, cold; pulse small, thready, not very quick. 
This man had, every minute, convulsive hiccough, so strong as to jerk his 
whole body, and to ring through the ward with a loud echo. The hiccough 
frequently raised into his mouth, and forced him to discharge by an act, partly 
of spitting and vomiting, a green slimy matter resembling the juice of fresh 
masticated leeks or grass. He was treated by the warm bath, cups to the 
epigastrium, blisters, renewed over and around the region of the stomach; 
internally, the free exhibition of carbon and magnesia, and the effervescing 
draught with a few drops — five at a dose — of tinct. opii. The hiccough lasted 
without intermission, for two days, slowly decreasing in force; then intermitted 
for some hours, and was renewed more weakly, until the evening of the third 
day, when it ceased altogether, and the man got rapidly well. Increasing the 
dose of magnesia was found to exert decided abating controul over the hic- 
cough, and when it purged freely, all the symptoms were relieved. The 
stools for three days were black green.— -W. 



310 Wright on the Warm Bath in Season Fever, 

«In stating the above number of cases, I have been confined to those ^s- 
ting-uished by prominent gastric symptoms. The milder cases, intermittens of 
the regular or complicate form, by the register, exceed one hundred, all of 
which have recovered, or are now convalescent. Twenty-two of these cases, 
more or less complicated when admitted, with visceritis, (subacute,) were 
treated by myself. Of this number, not one was put on the use of any of the 
mercurial preparations. The treatment was local and constitutional; cups and 
blisters repeated in many cases. General treatment, repeated moderate purg- 
ing, vomiting, and diaphoresis; bland drinks, and simple farinaceous food. 
When a tonic was employed, it consisted of sulphate of quinine, combined with 
an alkali, which in most instances kept up a gentle action of the bowels. 

"I have appended an outline of Oliphant's case. — Peter Oliphant, (labourer on 
the rail-road,) was admitted into this house, Sept. 10th. — State when ad- 
mitted, partly comatose, countenance sallow; deep and slow inspiration. Head 
somewhat retracted, spasmodic shrugging of the shoulders, and twitching of 
the muscles of the face and neck; pulse small and weak, not frequent. The 
integuments on the back of the neck and between the shoulders, red and 
puffy; great sensibility, (shrinking,) to pressure over the surface of the body, 
particularly on the back of the neck. On raising this man up, (to examine the 
neck and back,) after he had been in bed a few hours, a perfectly limpid fluid 
ran from both ears, amounting in quantity to a drachm; a circumstance the 
more remarkable, as there was nothing like moisture on the surface of the 
body. 

" This case you prouuunced to be season fever in its mature stage; in which 
arachno-spinitis was fully developed. The state of the patient when admitted 
did not allow a hope of recovery; he was attended to carefully — but died in a 
few days. 

" Dissection twelve* hours after death. An incision was made in the course of 
the spine from the occiput to the sacrum, when the nature of the infiltration 
in the back was explained. Diffuse inflammation of the cellular tissue, had 
ended in suppuration, and the skin of the back was extensively detached by a 
puriform fluid amounting in quantity to many ounces. The spinal canal 
was then opened. The dura mater of the spinal chord was extensive- 
ly separated, and loaded by effusion ;f blood was extravasated at many points, 
especially about the roots of the intervertebral, (cervical and dorsal,) nerves.t 
The whole spinal chord was enveloped in a web of congested vessels; and small 
vessels finely injected could be seen abundantly traversing the nerves after 
their exit from the spine. 

* Instructions had been given, that shortly after death the subject should be 
turned on the face, to prevent as much as possible, the state of the cerebro- 
spinal membranes from being disguised by post mortem infiltrations. — W. 

•\ Two or three large vesicular formations, (bullae, ) of the arachnoid coat, 
were strikingly prominent on the cervical tract of the chord. — W. 

i^ The roots of all the cervical nerves, (those of the spine,) were covered by 
a clot of blood extravasated into the cellular tissue of the chord. The ligamen- 
tum denticulatum was strongly dyed — (blackened)— by the same infiltra* 
tion.— W. 



Ruan's Case of Elephantiasis of Scrotum. 311 

" Encephalon— Base of the brain enveloped in fluid.* All the tunics of the 
brain, the arachnoid particularly, tinged red, and their vessels minutely in- 
jected.— Stomach — Mucous coat studded with deep red patches." 

Baltimore, Dec, 1829. 



Art. III. Case of Elephantiasis of the Scrotum successfully extirpat- 
ed. By W. H. RuAN, M. D. of St. Croix. (Communicated in a 
letter to John Ruan, M. D. of Philadelphia.) 

1 HE following case will probably be considered interesting, espe- 
cially from the enormous size of the mass extirpated. 

The subject of the operation was a negro lad, about nineteen years 
of age, named Moses, living on the estate La Grange, the property 
of the heirs of Count Schimmelmann. He had been afflicted, from his 
early boyhood, by repeated attacks of an erysipelatous inflammation 
of the scrotum, penis, and surrounding skin and cellular substance, 
which very soon produced an elephantiasis of those parts. This en- 
largement continued to increase, and to spread further on the infe- 
rior part of the abdomen, on both groins, and on the upper, anterior, 
and interior surfaces of both thighs. The growth of the tumour was 
said, by those who were in the habit of observing it almost daily, to 
have been most rapid during the twelve months immediately preced- 
ing the operation. At the time when I was requested to examine the 
case, the tumour presented a most unwieldy mass of a globular form, 
reaching three or four inches below the knee-joint, of a diameter of 
eighteen or twenty inches, and possessing distinctly all the external 
characteristics of elephantiasis. These last have been so well and so 
frequently described by authors on the diseases of tropical climates, 
that I need not here enumerate them. The diseased prepuce, enlarged 
to the size of a goose's egg, and of an irregular cauliflower appear- 
ance, was situated nearly in the middle of the anterior surface of the 
tumour. No other trace of a penis was perceptible. This organ, as 
well as the testes, were imbedded so deeply in the body of the tu- 
mour, that they could not be felt by the hand. The spermatic cords, 
however, could be distinguished, by grasping the part very firmly 
high up; and I felt convinced, by an attentive examination, as well 

* When the theca vertebralis was opened just behind the great occipital 
hole, a watery fluid rushed out of the cranium — to the, (apparent,) amount of 
four or five ounces. — W. 



312 Ruan's Case of Elephantiasis of Scrotum. 

as by the history which was given to me of the case by intelligent in- 
dividuals, that although the cords themselves were diseased, yet that 
no hernia protruded at the inguinal rings. The inguinal glands were 
much enlarged. The patient could pass his urine freely, and ad libi- 
tum. His general health, except when under an inflammatory attack 
of the diseased parts, was good. He had, I need scarcely say, never 
enjoyed the sexual intercourse; not even the sexual appetite; and had 
for some time previously to my seeing him, been entreating to have 
the whole tumour removed by the knife. 

As I felt convinced that the operation, if successful, would be the 
means of prolonging his life, and as the emasculation of a being in 
his diseased condition, could be of no ulterior consequence, I resolv- 
ed on performing it. For this purpose he was conveyed up to the hos- 
pital of the estate La Grande Princesse, also the property of the 
heirs of Count Schimmelmann; this estate being much nearer to the 
place of my residence. During the first fortnight after his arrival at 
La Grande Princesse, he was directed to wash the diseased parts 
three times a day with soap and water, to take two or three doses of 
purgative medicine, and to use a mild vegetable diet. 

Assisted by Dr. Jacobs of this town, (Christianstaed,) I proceed- 
ed to perform the operation on the 8th of November, 1828. On exa- 
mining attentively the neck of the. tumour, we found that very little 
sound skin could be employed in forming the lips of the wound, 
which it would be necessary to make in a circular direction around 
the neck; that the whole tumour was somewhat warmer than usual, 
and of a reddish hue, as if it were in a state of incipient inflamma- 
tion. As we were of opinion that these circumstances were not of 
such consequence as to render any procrastination necessary, we 
proceeded to perform the operation forthwith. The patient was placed 
on his back on a table, his legs drawn up as in lithotomy, but with- 
out binding his wrists and ankles together. The tumour being turned 
up on his abdomen and chest, and held in that position, I commenc- 
ed the operation by making an incision through the skin and part of 
the diseased subjacent cellular substance, in a circular direction, 
around a portion of the neck of the tumour, commencing at the 
perinaeum. As I prolonged this external incision around the neck, 
I dissected out the diseased mass from under that part of the 
skin which was sound, and detached it from its firm adhesions 
to such parts of the unsound, as were required to form the lips 
of the wound. In this stage of the dissection, we found the bulb 
of the urethra so much displaced from its natural situation, and 
80 imbedded in the disease, that we thought it best to continue the 



Kuan's Case of Elephantiasis of Scrotum, 313 

external incision of the neck of the tumour, and prosecute the dissec- 
tion from above downwards^ although, by this mode, the bleeding- 
prevented us from seeing so distinctly the parts to be divided. I 
now removed the diseased substance from the lower part of the abdo- 
men, from the pubes, and spermatic cords. A broad tape was next 
passed around each of the cords, so as to prevent haemorrhage from 
their vessels. The latter were secured by ligatures immediately after 
their division, and the tapes were then removed. The patient com- 
plained of slight colic pains during the application of the tapes, but 
was instantly relieved on the removal of the latter. The tumour was 
next detached from under the skin of each groin, and of about three 
inches of the upper, interior, and anterior surfaces of each thigh. On 
prosecuting the dissection further, we discovered the dorsum penis 
at least five inches beneath the anterior surface of the tumour. The 
penis was divided transversely, and close to the bulb of the urethra. 
The dissection was then rapidly concluded by the removal of such 
diseased substance as had not already been removed in the first 
stage of the operation. 

During the whole of the operation the patient was extremely rest- 
less, and on this account his suffering was prolonged to three times 
the duration that would have been necessary, could he have been 
persuaded to remain tolerably quiet. It was unavoidably, however, 
a tedious dissection. Arteries of considerable size and number, 
sprung at every cut of the knife,* and it was indispensably necessary 
to secure these, either by pressure with the finger, or by lio-ature, 
before we could proceed. Many arteries that appeared of considera- 
ble size from the first jet of blood which they threw out, contracted 
after a little pressure with the finger, and ceased to bleed. It was 
ultimately necessary, however, to secure eleven of them by ligatures. 
The veins of the tumour, as in almost all cases of elephantiasis, were 
very much enlarged, and in a varicose state. Two of them required 
ligatures during the dissection. The testes and penis were placed 
very nearly in the centre of the tumour. The spermatic cords, from 
the epididymis to the inguinal rings, were each eight inches in length, 
and much thickened. The testes were somewhat wasted away, and 
diminished from their natural size. The tunicse vaginales contained 
about four ounces of serum. Strong, ligamentous bands, connected 
the tumour with, and bound it to, the adjacent bones of the pelvis. 
The penis was much displaced, running out in a line at a right angle 
from the ascending ramus of the ischium and towards the centre of 
the tumour; and was much elongated and very slender; so that the 

No. XII — August, 1830. 28 



314 RusiXi^s Case of Elephantiasis of Scrotum, 

bulb of the urethra projected at least an inch and a half bejond the 
ischium. 

The incision through the neck of the tumour presented, when the 
latter was entirely removed, a flat surface of a circular form, and 
nine inches in diameter. That the penis and testes were so much dis- 
placed, and that the spermatic cords were so much elongated, will 
be no matter of surprise, when I inform you that the tumour, some 
time after it had been removed, and after at least two pounds of 
bloody serum had oozed from it, weighed, (in the presence of seve- 
ral gentlemen,) thirty-eight pounds. This enormous mass, when cut 
into, presented throughout its whole bulk, the usual peculiar appear- 
ances observed in the skin and cellular tissue in all cases of ele- 
phantiasis. 

At the conclusion of the operation, the patient was much exhaust- 
ed; but this proceeded evidently more from pain, and the struggles 
which he had made, than from loss of blood. Of the latter, he did 
not lose more than eighteen or twenty ounces; a quantity too incon- 
siderable to have produced such an effect upon his robust frame. By 
administering to him a few drops of laudanum and some Madeira 
wine, his strength rallied, and enabled us to proceed with the dres- 
sing of the wound. A female catheter having been introduced into 
the bladder, the edges of the wound were brought very nearly toge- 
ther from either side, by approximating the thighs to each other, and 
were retained in that situation by five stitches of strong thread. The 
dressing was then completed by laying on some lint and a few pled- 
gets of soft linen; and by retaining these in their situation by means 
of a T-bandage, through which an aperture was made to allow the 
projecting part of the catheter to pass. The thighs being bound close 
to each other, the patient was put to bed. His pulse had now resumed 
its usual strength and frequency; and he expressed much satisfaction 
at his having got rid of such a load of disease. 

The urine, during his recovery, was drawn off regularly three 
times a day, by means of the female catheter, which was kept in"the 
bladder during the healing of the wound. No unpleasant symptom 
whatever occurring, the dressings were not removed until the fourth 
day. On examining the wound at this time, I found three small 
patches of the diseased skin sloughing off near the stitches over the 
pubes: the rest of the wound, (particularly that which was situated 
between the orifice of the urethra and the anus,) looked healthy. He 
had had slight feverish symptoms during the first and second day 
from the operation; but these had now entirely left him. He said 



I 



Jackson on Rhubarb in Hsemorr holds, 315 

that he felt well, and in good spirits. I cut out the stitches in the vi- 
cinity of the sloughs, and directed that a warm bread poultice should 
be applied, and repeated four times a day to them; that the rest of 
the wound be dressed with lint; that his bowels be kept mode- 
rately open, by the use, occasionally, of small doses of Glauber's 
salt, and that he have a generous diet. 

On the twenty-second day after the operation, all the ligatures 
had come away from the blood-vessels, the stitches had been remov- 
ed, and the whole aspect of the wound was florid and healthy. By 
continuing nearly the same treatment, and by confining him con- 
stantly to the recumbent posture, the wound finally healed in its 
whole extent, in about eight weeks after the operation; forming a ci- 
catrix running in a direct line from the upper part of the symphysis 
pubis towards the anus. 

On the 26th of January, 1829, Moses returned to his work on the 
estate La Grange. 

St, Croix, February .^ 1830. 



Art. IV. On Rhubarb in Haemorrhoids, By Samuel Jackson, 
M. D. of Northumberland. 

JjR. RUSH was accustomed to observe in his lectures, that we 
needed no new medicines, and that improvements in the materia medica 
were rather to be expected from a more careful investigation of the 
virtues and doses of those we already possess, than from a further 
extension of the catalogue. Though we cannot accede to this propo- 
sition in its full extent, we are well assured that much is yet to be 
learned, concerning the latent virtues of many remedial agents; nor 
do we despair of living to see the time when calomel shall be made 
to exert all its various virtues without inflaming the mouth, and when 
tartar emetic shall annihilate fevers without the danger of nausea. 
Whoever, indeed, shall consider the many new and unexpected uses 
of these truly polychrest medicines, which have been brought to light 
wi^iin the last ten years, will not be unwilling to admit that some- 
thing new may be hoped for in every potent article of the materia 
medica. Nor ought this to be considered as a barren field of inquiry, 
for this department of medicine has made but little progress since 
the days of Cullen, as though the extreme medical scepticism of 
the great man had damped the ardour of all his successors. 



316 Jackson on Rhubarb in Hdemorr holds. 

It has fallen to our lot during eighteen years practice, to treat an 
unexpected number of haemorrhoidal cases, and we have therefore 
sought diligently for the best means of opening the bowels, in this 
troublesome and painful disease. In our early practice, too, we met 
with many cases among pregnant and puerperal women, in which, 
above all others, some prompt means of relief, and also some certain 
preventive, became a serious desideratum to the young practitioner. 
All the various laxatives recommended in books were repeatedly 
tried — none of them with entire satisfaction, and some with manifest 
injury. But we at length found in rhubarb a medicine, which, in our 
hands, has entirely superseded every otherj and we have for the last 
seven years prescribed it, not only for the purpose of relieving, but 
also of preventing the disease when threatened, and even of abso- 
lutely curing it in its inveterate stages. Whence this knowledge was 
derived, we do not recollect; there is not a hint of it in any book that 
we have read, and therefore it is hoped that these few pages may be 
the means of relieving or of preventing a great amount of vexation 
and pain. 

In the treatment of this disease, the business of the physician is to 
preserve a continually loose state of the bowels, without the use of 
any drastic or acrimonious purgative; or in other words, to avoid on 
the one part, the least tendency to costiveness, and on the other, 
every thing like severe purging, or even a relaxing diarrhcea. Some 
means, therefore, he must seek, which shall procure, in some cases 
one, in others two or three, loose but consistent stools every twenty- 
four hours. The best medicine, beyond all comparison, that we have 
tried to answer this indication is rhubarb. A patient who is haemor- 
rhoidal and costive may chew a piece of the root every night—some- 
times more, sometimes less frequently, but always so as to ensure one or 
more large loose stools every twenty -four hours. He ought to masticate 
it for at least fifteen or twenty minutes, and then to swallow the whole 
mass thus mixed with his saliva. If it prove very offensive at first, 
let him be assured that a taste for it may be as soon acquired as for 
tobacco, or some other uncongenial articles; so true is this, that I fre- 
quently meet my patients in the street, with a piece of rhubarb in 
the mouth, as we sometimes see persons with a quid of less whole- 
some medicine. If the patient chew it with his fore-teeth only, and 
confine the mass to the front of the mouth, it will prove less disa- 
greeable than when diffused over a larger space. This is by far the 
best method of using rhubarb as a laxative, as ten grains thus chew- 
ed is more operative than five times this quantity taken in powder, 
and swallowed ajt once. Whether this is owing to the admixture of sa- 



Jackson on Rhubarb in Hsemorrhoids, 317 

liva is not known; Dr. Rush used to say that the medicine thus taken 
made a more diffusible impression on the system through the organ 
of taste. Cullen directs that the ligneous part should not be swallow- 
ed. '* I have found that the purpose mentioned, (i. e. laxative,) may 
be obtained if the rhubarb is chewed in the mouth, and no more is 
swallowed than what the saliva has dissolved. In that case it appears 
to me that the astringent quality is not largely extracted, and there- 
fore the cathartic will operate as required." This supposed separa- 
tion of the astringent from the laxative principle, we suspect is erro- 
neous — let the chewers of rhubarb decide for themselves. 

This medicine then, as far as laxatives are needed^ we confidently 
recommend in hsemorrhoids, as a remedy of surprising efficacy; and 
if any competent physician, upon fair experience, shall find himsel 
disappointed, he is desired to pass over any thing we may hereafter 
publish. 

It is not pretended, however, that rhubarb will cure every bad or 
inveterate case, or that it is not to be occasionally assisted by vari- 
ous means. One important coadjuvant is a laxative diet, and the 
most necessary article of this is bread made of unbolted flour.* Nor 
can the knife or ligatures be always dispensed with — a severe, but 
very often a sure means of relief. 

Independent of those large tumours, about which surgeons have 
written so much, there often occur some that are small, but exces- 
sively painful, and of a purple colour, denoting that they contain 
extravasated blood. Upon making an incision into these, a hard nu- 
cleus of blood starts forth, or can be gently pressed out, and by the 
consequent removal of tension, as well as by the subsequent heemor- 
rhage, a large portion of suffering is prevented. But if the base of 
these tumours are small, we rescind them with one stroke of the 
scissors, which is by far the best method of effecting a radical cure. 
These tumours, containing nuclei of extravasated blood, are not, 
to our present recollection, described in books, yet they must have 
been continually coming under the care of physicians, who have pass- 
ed them over in the hurry of composition, upon the principle, that 
*« what is known is not always present." 

For the prevention and cure of hcemorrhoids in puerperal women, 

* This is the household bread of the Eng-lish; the joams impurus velfurfura- 
ceusy which, according- to Pliny, the Romans used exclusively for more than 
three hundred years; it is the common bread of the hardy Westphalian pea- 
santry; it is commended as a laxative by Hippocrates; the ancient ludatores used 
no other; and if we are not very greatly mistaken, there is hardly a condition 
of the human body to which it is not more congenial than the ivhite bread, 

28* 



318 Jackson on Rhubarb in Hsemorrhoids. 

we have found in rhubarb a medicine of inestimable value. As a lax- 
ative during pregnancy, it is the very best medicine we have tried. 
In this state of the system, we are certain that many, very many wo- 
men, unwittingly suffer severely from costiveness, and thus prepare 
for themselves a hard labour, a protrusion of hsemorrhoidal tumours, 
a feverish confinement, with a greater tendency to nearly all the 
complaints which are incident to the puerperal state. It is not enough 
that during the last months of pregnancy, a free stool shall be pro- 
cured once in the twenty-four hours. Most women have an inordi- 
nate appetite during this period, and they are with infinite difficulty 
restrained from eating too freely; nay, they are often encouraged to 
do so, under the opinion that the foetus is to be nourished, as well as 
the mother. On this point the practitioner ought to be on his guard, 
for the consequence is, that they become loaded with offensive fecu- 
lent matter, which produces restless, feverish nights, oedematous 
limbs, if not a general anasarca, dyspnoea, and very frequently the 
most painful heemorrhoidal tumours. All these evils may be prevent- 
ed — not by using rhubarb as a mere laxative, but by chewing it in 
such quantities, as to produce free and thorougli catharsis every day. 
It is true, the lancet and exercise in the open air, particularly in a 
carriage, are called for; but purging — copious purging, cannot or 
ought not to be dispensed with. 

If the hsemorrhoidal patient suffer from heart-burn, let her not taste 
magnesia. She may use super-carbonate of soda or of potash, but ne- 
ver magnesia, for reasons which we shall mention below. If haemor- 
rhoids are found after delivery, let the practitioner replace them im- 
mediately if he can do it without too much violence, and the nurse 
or the woman herself ought to be instructed to do it, if they subse- 
quently come down. But the operation must be done in the most ef- 
fectual manner — idioque digitus in anum placide inserumdus est. 

It is common to prescribe some neutral salt or castor oil as a pur- 
gative during the period of child-bid; but if there be the least ten- 
dency to hsemorrhoids, the chewing of rhubarb is far better, i In this 
state, however, it must be used in larger doses, as well as more fre- 
quently, and when it is expected to operate the first time after deli- 
very, a bland enema ought to be administered. If hsemorrhoids again 
protrude, they ought to be replaced, and some emollient ointment 
used. By these little precautions, which are neither troublesome nor 
painful, a large amount of the most severe suffering may be pre- 
vented. 

In what we have here written on the use of this medicine, we have 
not the least fear of contradiction from the experience of others, pro- 



Jackson on Rhubarb in Hsemorr holds. 319 

vided they administer it with sufficient freedom. One thing must be 
observed — it may prove necessary, in some constitutions, to modify 
its operation with a little ginger, caraway, fennel, or some other aro- 
matic, and in those habits that admit of spirits, the Warner's cordial is 
an excellent preparation. It is observed by Dr. Chapman, Therapeu- 
ticSy Vol. I. p. 9>5Q, that laudanum does not prevent the operation of 
this medicine. On this proposition we have not had sufficient expe- 
rience, but Hartshorne's acetated tincture of opium, which we com- 
monly use instead of common laudanum, seldom induces costiveness 
under any circumstances, and therefore it may be given to prevent 
the griping pains that rhubarb induces in some constitutions. This is 
prepared according to a recipe in the Philadelphia Journal, Vol. XIV. 
p. 246. Turkey opium, ^j.j strong vinegar, ^vi.; alcohol, ^iv. Tri- 
turate the opium with the vinegar, add the alcohol, and digest for 
ten days, (or longer.) 

This is a substitute for the uncertain preparation black drop, and 
is supposed to be suitable to those constitutions on which laudanum and 
common opium operate in a well known unfriendly manner. This 
proposition is true in part only, for while it comforts some of these 
excitable persons, it distresses others in the usual way of common 
laudanum. Here then we have the most happy resource in the denar- 
cotized opium, which we confidently believe, from much experience, 
brings comfort to all. But, "nil omni parte beatum," it occasions 
costiveness like common laudanum. Whether this evil, with all the 
rest, is avoided by Carpenter's acidified tincture of denarcotized 
opium, we have not satisfactorily ascertained^ but from some experi- 
ence we are ready to believe that it is the best preparation of opium 
now before the public* 

As we have set about writing what we have learned from experi- 
ence, and not from others, we shall mention another useful means of 
preventing the disease. When the rectum is known to be loaded with 
hardened fseces, the hsemorrhoidal patient ought always to soften the 
mass with an enema of warm water, and to dilate the passage with 
his finger covered with pomatum or some bland ointment. These 
means we have often recommended, to the great comfort of those'af- 
flicted with a contracted and sore state of the anus from haemor- 
rhoids. 

The old and almost established opinion, that aloes are pernicious 
in this disease, has lately been so far controverted in London, that 
this medicine is now given both as a preventive and cure. From our 

, * See Philadelphia Journal, Vol. XIV. p. 244. 



320 Jackson on Uhuharh in Hsemorrhoids, 

own observations, we are rather inclined to the old prejudice, but can- 
not positively decide. Among the worst purges in this disease, is ca- 
lomel and its compounds. We have known persons who could not 
take five grains, without suffering from it the most painful hsemor- 
rhoids; but of all cathartics, the magnesia is to be avoided v/ith the 
greatest care, and particularly the calcined. It produces a sensation 
of intolerable ardor as it passes through the rectum; so great that pa- 
tients have even resorted to the use of cold water to allay it. This 
burning is supposed by a most talented man, and a competent obser- 
ver, to be owing to an uncombined acid passing through the rectum.* 
This we have many reasons to believe, is entirely erroneous — let ex- 
perience decide. 

It is commonly supposed that riding, and particularly on horse- 
back, is bad for the piles. This, we are satisfied, is mere prejudice, 
and that it has no such effect, provided costiveness be carefully avoid- 
ed. We have known persons who appeared half their time on horse- 
back, some of full habits and free living, who yet knew nothing of 
this disease. Costiveness is probably always the direct or indirect, 
the remote or the exciting cause of haemorrhoids. We have known 
many young ladies to suffer severely from it, who had never been on 
horseback, and seldom in a carriage, but who, in their mistaken con- 
ceptions of an elegant form, had destroyed their capacity for food by 
tight lacing, so far indeed that some of them would pass from five to 
twelve days without an alvine discharge. This we are desirous of 
mentioning, as young practitioners may be often deceived in these 
cases, and may indeed be unwilling to inquire very carefully into 
these delicate affairs; for, as Linnaeus says, on a sim.ilar occasion, 
"harum rerumindagatio curiosior abominabilis est." He ought to 
be apprised too, that both parents and children will obstinately deny 
the fact of tight lacing, and this they may often do with a good con- 
science, since this tightness, like every thing else, is judged by com- 
parison, and in this case, with minds by no means unbiassed. 

If these hints of the virtues of rhubarb should prove the means of 
introducing it into general use, in the treatment and prevention of 
hsemorrhoids, we venture to predict that a great amount of pain will 
be thereby averted; nor can this fail to enhance the reputation of the 
medical attendant, since whatever physician is able to bring the 
greatest comfort with promptness and safety, will generally be es- 
teemed the best. Let it be observed, however, that we propose rhu- 
barb merely as a laxative in this disease, nor do we presume that it 

* See Thomas Cooper, M. D. on Domestic Medicine. 



' Carter on Mania a Potu. 321 

possesses any other anti-haemorrhoidal virtue — of its accidental be- 
nefits in the same cases, we are not now treating; the reader has al- 
ready learned them from various books and from experience— but if 
it possess no other than its laxative powers, we must contend that 
these are quite peculiar, and admirably adapted to the cure of hse- 
morrhoids. Costiveness is attended with such a multitudinous con- 
catenation of evils, and rhubarb is so peculiar and salutary in this re- 
spect, that if any one is at all disposed not to pass a morning without a 
free evacuation, particularly if he be plethoric, bilious, gouty, in the 
decline of life, or the least disposed to heemorrhoidal tumours, let 
him chew this medicine — I had almost said every day and night of 
his remaining life. 

Northumberland^ Penn. May^ 1830. 



Art. V. Observations on Mania a Potu. By Jesse Carter, M. D. 
one of the Resident Physicians of the Philadelphia Alms-house In- 
firmary. 

Among the varieties of mania which I have observed, none have 
arrested my attention, and interested my feelings so much as mania 
a potu. The history of this form of cerebral disease is short. Pre- 
viously to the commencement of the present century, it was not 
known as a distinct affection; but was confounded with mania from 
other causes, and of course subjected to similar treatment. The 
mortality consequent to this error, was so great, that a very eminent 
physician despaired of the recovery of almost every case to which he 
was called. The first distinct account of it, was published by Dr. 
Pearson, of Newcastle, about 1801; it was subsequently described 
very succinctly and ably, by Dr. Sutton, whose experience appears 
to have been confined to the lighter grades of the disease. Since 
then, it has been variously described by numerous writers, particu- 
larly in our own country. A very elaborate essay on the subject, 
was published a few years since, by Dr. C gates of this city. It was 
with the unsettled and indistinct ideas, produced by the almost con- 
tradictory statements of different writers, that I undertook the charge 
of the cells of the Philadelphia Alms-house, where this disease is 
very common. 

After a careful examination of the symptoms, and the modus ope- 
randi of the remedies employed, I became convinced, that writers 
had taken too limited views of the subject; that each plan was bene* 



322 Carter on Mania a Potu. 

ficial under particular circumstances, but that a combination of them, 
so as to suit the existing state of the system, was still more advan- 
tageous. 

Having enjoyed an extensive opportunity of observing the disease, 
and of marking its progress, I am induced to oflfer for publication in 
this Journal, a few remarks upon its symptoms, pathology, and 
treatment. 

The disease is generally preceded by irregularity of thought; de- 
ficiency of memory; anxiety to be in company; excessive peevishness; 
passions excited by the most trivial circumstances; the mind active 
and wandering from subject to subject. Objects exciting horror per- 
petually present; excessive nervous tremors; constant jactitation; 
slumbers short and interrupted by frightful dreams; which are fol- 
lowed by continued watchfulness, as the disease advances. The 
countenance is generally of a leaden hue; frequently flushed with in- 
dication of great anxiety. The eye is often muddy and dull, occa- 
sionally in violent cases injected; though generally it is not much af- 
fected. The state of the pupil varies; it is sometimes contracted, at 
others dilated, under apparently the same group of symptoms; the 
former state, however, is most frequently met with. The skin is 
differently affected, sometimes it is warm and dry, but usually cool and 
damp, and occasionally covered with profuse cold sweats. This state 
of the surface, is most frequently met with, among those who have 
been long accustomed to the excessive use of spirituous liquors. 

The tongue is generally clean, though sometimes, when the 
primse viae are much deranged, it is coated with a yellow fur. In 
the latter stages of the disease, it becomes very dry and chopped. 
There is generally, preternatural heat about the head, attended oc- 
casionally with pain, oftener with fullness and heaviness. The pulse 
is commonly full, but compressible and not very frequent. In old 
drunkards, the pulse is small and undulating, and as the disease ad- 
vances to a fatal termination, it becomes weaker and more frequent. 
In i\\Q. commencement of the disease, the stomach is often considera- 
bly affected, which is indicated by a want of appetite, nausea, and 
sometimes vomiting, but as the mania becomes developed, the unplea- 
sant sensations disappear. The bowels are confined, but rarely ope- 
rated upon by medicines. The condition of the muscular system 
varies according to the state of the constitution. Those who have 
not been seriously injured, sometimes exhibit extraordinary instances 
of strength, whereas, in persons who have been long victims to intem- 
perance, there is generally an agitation and unsteadiness in their 
movements, so as to indicate great weakness. 



Carter on Mania a Potu, 323 

The state of the intellectual functions vary very muchj patients who 
are robust, are occasionally very violent, rendering it necessary in some 
instances, to subject them to restraint; but those who are more ad- 
vanced in years and have been long victims to excesses, are very 
easily managed. A patient labouring under this form of mania, is in 
a state of perpetual excitement, laughing and talking by turns inces- 
santly. Frequently he will converse with his medical attendant, 
about his ordinary affairs with great precision, telling him that he has 
been constantly engaged in matters of high import; having visited 
several places since he saw him, though he has not moved out of his 
room. If he be contradicted in any of his phantasies, he adheres to 
them very pertinaciously, and becomes much enraged; but if he be 
dealt with kindly and soothingly, and his attention gained, he will 
generally reply to questions very correctly. 

The cause of all this confusion of ideas, is the derangement of the 
faculty of perception; the judgment upon the subjects presented to 
it, is wonderfully correct. Observing on one occasion, a patient 
trembling in the corner of his cell, I asked him, what was the mat- 
ter; to which he replied, that there was a rattlesnake under his bed, 
and that there were some persons who were tr3dng to shoot it; and in 
order to escape being shot, he had left his bed, and taken refuge in 
that position. I have also seen a patient pressing against the wall, 
with his utmost force, in order, he said, to prevent its crushing him. 
The objects of delusion vary very much. Sometimes patients are 
annoyed by cats and mice; frequently by snakes; occasionally they 
imagine the devil has presented himself, and claimed them as his 
property. One of the patients perpetually saw some one at the win- 
dow, wishing to shoot him. Writers on this subject, record many 
singular cases of aberration and self-delusion, the details of which 
are more curious than useful. Convulsions have not been very fre- 
quent to my observation. Out of nearly a hundred cases, there were 
not more than a dozen with epileptic symptoms, except when they 
were the immediate precursors of death. 

The preceding is a short history of the disease in its simple form. 
It is, however, often complicated with other affections, particularly 
when it occurs during the hot season of the year, when it presents 
more decided marks of inflammation, and is much more difficult of 
management, and more fatal in its result, than at any other period. 
This condition in its early stage, is characterized by a pulse much 
more tense than usual; tongue red at the edges; often very dry and 
cracked; head-ache; less quickness of comprehension; eyes often in- 
jected; skin dry; delirium very violent. A second stage soon super- 



324 Carter on Mania a Potu. 

venes, when the skin is bedewed with cold clammy perspiration; 
pupils are contracted; pulse very frequent and almost impercepti- 
ble; low muttering delirium; with gastric symptoms of an aggravated 
and unmanageable character, which continue until death closes the 
scene. 

Pathology. — In order to arrive at any definite ideas on this subject, 
it will be necessary to inquire into the causes of this disease, and 
their mode of action on the system. The predisposing causes are 
admitted by all writers to be the habitual use of diffusive stimuli; 
but more particularly of ardent spirits. The delirium of opium- 
eaters, is partially the same, only of a more aggravated character. 
The first impression of these stimuli is to excite the powers of life, 
to elevate the mind, and to render the imagination vivid. This ex- 
citement after a longer or shorter duration, is always followed by a 
state of depression; the system becomes weakened, the sensibilities 
blunted, and the spirits dejected. To escape from these uncomforta- 
ble sensations, the unhappy victim has again recourse to stimuli; this 
is again and again repeated, sometimes for several weeks; the patient 
during this state of almost perpetual intoxication, takes but little 
nourishment of any kind. The stomach so long accustomed to these 
excessive potations, at length requires their constant use, to enable it 
to perform its functions in the animal economy. Should the patient 
under these circumstances break off suddenly, and abstain altogether 
from his accustomed stimuli, the abrupt withdrawal of so much ex- 
citement, would weaken very much the general action of the system, 
producing very considerable exhaustion; but in every depression, 
nature makes an effort to react, so that shortly, there is developed 
preternatural action, particularly in the brain. The patient is in a 
state of perpetual watchfulness, the imagination is constantly em- 
ployed in conjuring up objects which are not present; these halluci- 
nations increase until mania a potu becomes fully developed. While 
the nervous system is in this state of excitement, the other organs of 
the body are more or less weakened, as is evinced by the softness of 
the pulse; the languid capillary circulation; the coldness and pale- 
ness of the surface, &c. 

As the result of all my observations and reflections, I should say, 
that the disease consisted essentially in a morbid excitement of the 
brain, as is exemplified in the increased activity of its functions, with 
a depression of those of organic life. My limits will not permit me 
to enter into an examination of the theory which ascribes the disease 
to gastric origin, or the one lately advocated in Germany, of its con- 
sisting essentially of meningitis. As high authority may be adduced 



Carter on Mania a Potu. 325 

in favour and against these opinions, I feel a reluctance in adducing 
my own, particularly as the post mortem appearances presented in 
mania a potu, do not always satisfactorily illustrate the pathology of 
the disease. 

Brain, — The dura mater is rarely inflamed 5 I have no recollec- ' 
tion of having seen it in that state. The blood-vessels of the pia ma- 
ter are augmented in size, and generally congested, especially those 
of the velum interpositum. The tunica arachnoidea is thickened, and 
presents an opaque appearance, especially at the base of the cerebel- 
lum. Eflfusions of serum are often found in the ventricles, generally 
colourless, though occasionally sero-sanguineous. When the vessels 
of the brain are much congested, effusion is rarely observed. The 
morbid phenomena vary very much; in one case, in a patient found 
in the street in a state of stupor, with the subsequent development 
of mania a potu, a coagulum was found in the anterior and middle 
lobes of the right hemisphere of the cerebrum, of an oval form, about 
two inches and a half by two. The substance of the brain around the 
coagulum, was grayish and diffluent. I have seen two or three cases 
of a similar kind, though not so extensive. 

Stomach, — The mucous membrane is generally altered in structure, 
being thickened and smooth, the villi obliterated, with other marks 
of chronic gastritis. 

Liver. — Is much enlarged, exhibiting frequently the fatty degenera- 
tion, often granulated, of a yellow or fawn-like colour. The struc- 
tural alteration of these last-named organs, must be regarded as coin- 
cidences, rather than as illustrating the pathology of the complaint 
under consideration, since they occur in almost all diseases of habi- 
tual drunkards. 

Diagnosis, — The peculiar symptoms of this disease are difiicult to 
describe, but when once seen, they are never forgotten. An inquiry 
into the habits of the patient, the great activity of his mind, the con- 
stant perception of objects which are not present, the ease and doci- 
lity with which he takes the medicine prescribed, and the respect 
and deference paid to his medical attendant — all these circumstances 
will enable us to recognise the disease without much difficiilty. From 
the delirium of fever, it is distinguished by the suddenness of the at- 
tack, the patient a day or two previous being in apparent good health; 
from inflammation of the brain, by the more moderate degree of the 
attending fever; the pulse is softer; still more particularly by the ab- 
sence of turgescence of the eyes, and impatience of light, which is so 
characteristic of the latter disease; from confirmed mania, by the re- 
No. XII.— August, 1830. 29 



326 Carter on Mania a Potu. 

gular exacerbation of the disease as night approaches, and the ten* 
dencj to remit towards morning, the reverse of which takes place in 
regular mania. 

Prognosis. — The first attack in a constitution not much shat- 
tered bj disease, generally terminates favourably. But after the 
third attack, when the vital powers become very much weakened, 
the case is one which occasions great anxiety, requiring constant 
watching. In such patients, effusion on the brain is extremely apt to 
occur. When combined with inflammation of any of the vital or- 
gans, the prognosis is still more unfavourable. Convulsions are 
much to be apprehended; and with this complication almost all 
die. If the pupil be dilated or contracted, insensible to light; 
the eye wandering, and not resting upon any particular object, 
more imminent danger is threatened than merely from its injec- 
tion. A want of correspondence in the pupils is universally fa- 
tal. Short disturbed slumbers, accompanied with subsultus tendinum 
from which the patient starts with affright and then falls into a low 
muttering delirium, are very unfavourable. Those who take opiunn. 
in excess, are in greater danger than the mere drunkard. When 
there is constant increase of nervous tremors, pulse increasing in fre= 
quency, and at the same time becoming smaller and weaker, w^emay 
anticipate a fatal result. While, on the contrary, if the patient be- 
comes quiet, and falls into a sound sleep, we may expect a recovery 
though even here I have been occasionally disappointed. The disease, 
as has been already stated, is much more violent and intense during 
hot weather than in more temperate seasons; though the mortality 
may be lessened by judicious practice, the proportion of fatal cases 
must always be greater. In the Philadelphia Alms-house, between 
the 1st of November, 1828, and the 1st of February following, out 
of seventy cases, there were only nine deaths, being a little more 
than one in eight. W^hereas, between June 10th, 1829, and Septem- 
ber 10th, following, out of seventy-five cases, there were eighteen fa- 
tal, being about the proportion of one to four. 

Treatment. — When the first symptoms of mania a potu are begin- 
ning to be developed, attended with strange hallucinations, with 
great restlessness, but the patient still rational, all the unpleasant 
symptoms are occasionally dissipated by the timely employment of 
an anodyne, which, by inducing sleep, quiets the excessive action of 
the nervous system, and gives rest to the exhausted frame. To meet 
these indications, when the stomach would bear it, I have found the 
following combination very serviceable. R. Lac assafcetida, ^vj. ; acet. 
tinct. opii, Jij- Cf which a table-spoonful is to be given every hour or 



Carter on Mania a Potu. 327 ' 

two, according to circumstances. Its action is very much assisted by 
the free use of the tincture of hops. After taking this remedy, the 
patient will often awake refreshed, but weakened from his long fast, 
and is soon restored to his usual health by tonics and generous diet. 
It is too often our unfortunate lot, however, not to see the patient, 
until the disease is fully formed, when we must have recourse to 
measures which produce a more powerful and permanent impression. 
Among these opium first claims our attention. The dreadful eflfects 
which followed the antiphlogistic treatment, when exclusively relied 
on, may be readily imagined, since the disease is found to be gene- 
rally under the controul of such a powerful stimulo-narcotic as opium. 
Unhappily for the interests of humanity, physicians are too liable to 
run into extremes. Observing occasionally the surprising relief af- 
forded by this remedy, they had recourse to it exclusively, without 
paying any regard to the existing state of the constitution. In con- 
sequence of this error, the iiiortality, though diminished, was still 
considerable. In the employment of such potent agents, there should 
be great caution and vigilance. The stomach, so long accustomed to 
the use of powerful stimulants, loses its tone sometimes in a very ex- 
traordinary degree, so as not to be immediately affected by the re- 
medy, when given in very large doses. Suddenly, however, its sen- 
sibility is revived, and we are summoned to our patient, labouring 
under all the symptoms of poisoning from this drug. 

In cases of simple mania, with great coolness of the surface, with 
soft pulse, unaccompanied by any preternatural heat of the scalp, I 
would rely on opium, combined with the free use of his accustomed 
stimulus. It is not often that such cases have been presented to my no- 
tice; those of the infirmary belonging to the lowest class, and who have 
been accustomed for years to excessive drinking. Hence all their or- 
gans are in a state of derangement, occasionally there is gastritis, 
pneumonitis, hepatitis, and even inflammation of the brain. These 
complications render its management still more difiicult. Too often 
in such cases we are obliged to be mere spectators, being compelled 
to see death rapidly approach without possessing any means of ar- 
resting its progress. In most of such patients, opium would only 
hasten the termination. In cases where there is active determination 
©f blood to the head, as is evinced by the excitement of the mind, 
heated state of the scalp, flushed face, and injected and rolling eye, 
I have found it impossible to produce sleep by the exclusive use of 
epium. The system is exhausted by excessive exertion, the eye will 
retain its restlessness and watchfulness, the voice becomes more en- 
feebled, symptoms of stupor and insensibility, with stertorous breath- 



328 Carter on Mania a Potu. 

ing supervene, and the patient expires in a fit of apoplexy, or else 
lingers for several days, and finally dies of effusion on the brain. If, 
on the contrary, the active state of the system had been reduced, the 
inordinate determination to the head diminished by general and local 
depletion, and revulsion to the abdominal viscera by means of active 
cathartics, together with free use of cold to the head, and then the 
opium employed, it would no doubt have been followed by the hap- 
piest effects, in calming the excitement and producing sleep. 

There is no disease which I approach with so much dread as mania 
a potu; the uncertainty of success where it is most anticipated, and the 
occasional recoveries from apparently the most desperate circum- 
stances, always occasions anxiety and solicitude to the physician. 

It is stated by very high authority, that if we procure sound sleep 
all danger is at an end; but my observations have led me to a diflfer- 
ent conclusion, having repeatedly seen patients in the Alms-house, 
awake from a long and continued sleep0as delirious as ever, and the 
disease notwithstanding proceed to a fatal termination. From this 
view we are led to an erroneous practice, without any regard to the 
highly excited condition of the stomach and brain, which not unfre- 
quently prevails; we proceed to the indiscriminate use of opium, 
which, as might readily be supposed, only aggravates the symptoms. 
We are struck, while reading the records of medicine, with the 
omission of the effects of powerful remedies, when given imprudently. 
We find but few men who have sufficient moral courage to confess, 
that they have hastened the death of a fellow being by the excessive 
use of any remedy; hence the silence of authors, on the consequences 
of the exhibition of too much opium in mania a potu. Dr. Coates re- 
marks, that there are no limits to its use until the desired effect is produc- 
ed; that he has never seen, heard, orreadof any injury resulting from 
such bold procedure. My own observation has repeatedly shown me 
the error of this view. I have often seen patients become worse after 
every dose of opium, whereas, when suspended, and the excitement 
of the head reduced, and the opium then resumed, sleep would rea- 
dily be induced. I have no doubt of havipg witnessed several times, 
death hastened by the effects of opium. One case has made a distinct 
impression upon my memory. A young woman whom I saw in the 
evening, labouring under the disease in its most violent form, exces- 
sively delirious, eyes injected, and perpetually rolling, face flushed 
and scalp unusually hot. Opium was freely given during the night; 
next morning her eyes were fixed, breathing stertorous, subsultus 
tendinum, and in fine every symptom which authors describe as fol- 
lowing the use oftliis drug, when taken too largely. It is singular 



Carter on Mania a Potu. 329 

fhat in every other disease, we inquire particularly into the state of 
the patient, and modify our treatment accordingly, but in this most 
formidable one^^e throw aside all our usual principles of action and 
abandon ourselves to a blind and exclusive system of routine. 

After a careful perusal of the treatment as recommended by Dr. 
Coates, the only distinct ideas left on my mind were that sleep was 
the sine qua non, and opium the only remedy which should be given 
without fear, until sleep or death takes place, without any regard to 
the state of the system. Such exclusive rules are always detrimental. 
Though I would be very cautious in the exhibition of opium, still I 
would trust to it as my sheet anchor. Other remedies may palliate 
and assist, yet without its judicious application, we shall seldom 
witness a happy termination. My object in the previous remarks is 
not to lessen the value of the remedy, but only to render us more 
prudent in its use, and attend more strictly to the state of the sys- 
tem; and also to recommend the employment of some adjuvants, 
which I have found to succeed in a very happy manner. 

The quantity of opium which is necessary to be given, varies ac- 
cording to the condition of the patient. When the disease is fully 
developed, and the system is in a proper condition to bear it, it is 
necessary to begin with six grains, and repeat it in an hour; and then 
suspend it. When given in this decided manner, a very powerful 
impression is produced, and often the patient will fall to sleep in a 
few hours; but if this happy circumstance should not occur, and 
should excessive determination to the head exist, after reducing this 
excitement, I would recommence and pursue the same practice. I 
have no doubt that the exhibition of the remedy in this manner would 
save much time and uneasiness. When given in the small doses 
usually recommended, and continued at long intervals, we only keep 
up the excitement of the nervous system without the narcotic effects 
of the remedy being induced. The form which I generally pre- 
scribed was powdered opium. I occasionally employed the acetated 
tincture without any very evident advantage over the other. Besides, 
the strength of this menstruum is so variable as to forbid its general 
employment. I used it in a few cases in the form of an injection 
with decided benefit; the quantity prescribed was generally about 
one hundred drops, which was repeated when necessary. The salts 
of morphia have lately been employed with considerable success, but 
my experience of their utility is very limited; for as they were very 
expensive I did not feel myself at liberty to prescribe them often — 
but from the smallness of their dose, and their general operation on 

29* 



330 Carter on Mania a Potu. 

the system, I have but little doubt that they would constitute the 
preferable form for the exhibition of a narcotic. 

Blood-letting. — Occurring as this disease generally does in persons 
whose constitutions have been wrecked, or very much shattered, the 
system exhausted by want of sustenance for several days, venesec- 
tion is rarely demanded. The employment of it, in a majority of in- 
stances, would be extremely hazardous; and the practiser of so bold 
a measure, should rejoice if his patient did not speedily expire under 
the operation. Occasionally we encounter the disease in a young man 
who has not seriouslyinjured himself by his habits, connected with con- 
siderable excitement, pulse possessing more than ordinary force, with 
great determination to the brain; I should not in such cases hesitate 
to bleed freely. Writers on this subject are too much haunted by 
that spectre debility; hence they condemn depletion of every kind. 
In these cases, where the general strength will not bear venesection, 
but with too much activity of the sanguineous system for the suc- 
cessful exhibition of opium, the application of cups or leeches to the 
temples, or behind the ears, by their direct depletion, relieves the 
determination, and quiets the inordinate action of the brain, render- 
ing it more susceptible to the action of a narcotic. In fact, I have 
derived so much advantage from their employment, that I very rarely 
visited a case which would bear them without ordering either the 
one or the other; giving the preference generally to cups, as be- 
ing more economical and convenient, and creating a more permanent 
irritation externally; and in no one case do I recollect of their appli- 
cation being unattended with benefit. By paying attention in this 
manner to the state of the system, I scarcely ever had any difficulty 
in producing sleep. 

Cold applications. — The great sedative influence of cold has been 
generally recognised since the publication of the celebrated reports 
of Dr. CuRRiE. When called to a patient very wild, with great 
heat of surface, and action in the head, the dashing of a few buckets 
of cold water over the head, if the constitution has strength to react, 
is exceedingly beneficial. Cloths wrung out of cold water are not less 
serviceable. The extremities should at the same time be stimulated 
by means of sinapisms. By pursuing these remedies, the increased 
cerebral action is diminished, the excitement of the system equalized, 
the patient is then prepared for a favourable exhibition of opium, and 
other stimulants, which, without this preparation, would only aggra- 
vate the disease. It is of much importance to attend to the peculiar 
character of this form of the complaint, and regulate the remedies ac- 
cordingly. 



I 



k 



Carter on Mania a Potu. 331 

Purgatives.^— In this disease tiic absorbents of the mucous mem- 
brane of the primae viae appear to be so peculiarly inert, that by- 
stimulating the intestines with mild cathartics, the susceptibility to 
the action of other remedies is greatly increased. The best practice 
usually is, at the commencement of the disease, if the patient's 
strength will warrant it, to give a dose of senna and sulph. magnesia, 
or a purgative injection. In those cases, where active determination 
to the head exists, I know of nothing more useful than a brisk ca- 
thartic, in subduing the inordinate action, by revulsion to the abdo- 
minal viscera. I have tried in several instances, the combination of 
calomel and opium without any material advantage, and with the ef- 
fect, often of protracting the disease, and rendering the patient un- 
comfortable by a tedious sore mouth. 

Blisters. — The use of blisters in this disease, as a general rule, is 
very questionable. In cases of much excitement, they are inferior 
to topical depletion, and frequently by their irritation increase the 
restlessness and watchfulness of the patient; but when the active 
stage is past, and there is considerable danger of eftusion, their appli- 
cation to the back of the neck and extremities, is often followed by 
the happiest effects. 

Ardent Spirits. — These are remedies which are generally too lit- 
tle recommended. Many physicians, under what I consider mis- 
taken notions of morality, proscribe them altogether, not recollecting 
their obligations to use the most effectual means for the removal of 
the diseases of our frame. To prescribe them in this affection, does 
not sanction their employment in health, more than it does that of opium 
or any other remedies which may have been given. Individuals who 
have been so long accustomed to excessive potations, as to have in- 
curred the usual penalty, (mania a potu,) are fully sensible of the im- 
propriety of their manner of living, and of the desolating effects of 
ardent spirits on their systems. They want moral courage, however, 
to resist the cravings of the stomach for this destructive poison. The 
remedies of their physician, whatever they may be, have therefore, 
but very little influence on the subsequent course of the patient. In 
many cases of great nervous excitement, ardent spirits, particularly 
in those patients accustomed to their use, have decided advantage 
over any form of opium, and under such circumstances, the most con- 
scientious medical adviser, need not hesitate to sanction their use. 
From the pathological view of the disease taken in the preceding 
pages, it appears to be essentially connected with an exhaustion of 
the functions of organic life; this stimulus, by arousing its action, 



S32 Carter on Mania a Potu. 

would break up the train of morbid associations, and have a ten- 
dency to bring about that happy balance which constitutes health. 

Though in this disease, reliance has generally been placed upon 
opium, yet there are some adjuvants, which, by producing a sedative 
action, may enable us to diminish advantageously, the enormous 
doses of this article. Among these camphor stands the highest. 
Its first impression is that of a stimulant, but the ultimate effect is 
narcotic. During my residence in the Alms-house, it was repeat- 
edly tried without any evident advantage. Occasionally in opium- 
eaters it was very beneficial. I have found next to opium, assafoe- 
tida the most valuable remedy, and in those cases of gastric or cere- 
bral excitement where opium is inadmissible, it is by far the most ef- 
ficient agent j it calmed the patient, and produced little or no increased 
excitement. I order the lac assafoetida, as freely as the patient can 
bear it, and occasionally the substance; when there is great irrita- 
bility of the stomach, I preferred it as an injection. Occasionally 
in old drunkards, when the system is much exhausted, the pulse 
small and tremulous, skin cold and moist, limbs very nervous, the 
use of the ammoniated julep every hour or two, according to circum- 
stances, together with rubbing the surface with a decoction of can- 
tharides and spirit of turpentine, have had a most salutary effect. 
This treatment increases the action of the capillaries, and gives 
vigour to the general circulation. Afterwards, the moderate use of 
opium produces sleep, and a consequent mitigation of all the mania- 
cal symptoms. 

When the mania subsides, the patient is very weak, and requires 
the support of a generous diet. Under such circumstances, I have 
found soup made very strong with Cayenne pepper, porter, and the 
occasional use of the patient's usual stimulus, with an anodyne in the 
morning, rapidly restore the patient to his usual health. 

Before finally dismissing the subject, I will make a few remarks 
upon the modification which the treatment requires during the con- 
tinuance of hot weather, for however appropriate the plan generally 
recommended may be, in the simple disease occurring during winter, 
it is necessary to be very cautious, in those cases which are met 
with during summer. Patients prematurely placed upon opium, or 
even after some previous preparation, very quickly pass into the 
second stage, or fall into a state of coma, which is but the precursor 
of death. 

When the pulse is tense, countenance flushed, with head-ache, 
blood should be taken from the arm, but not very copiously. From 



Carter on Mania a Potu. 333 

eight to fourteen ounces is generally sufficient and free from danger; 
a greater quantity would probably occasion prostration. If gastric 
inflammation be present, cups, or what are more appropriate, leeches, 
should be applied to the epigastrium, and demulcent drinks freely 
administered — cups to the head should seldom be neglected in mania 
a potu; but in this form, topical depletion is imperiously necessary. 
Fomentations, with warm blankets, sinapisms to the extremities, 
and ice applied to the head, after being shaved, are very useful. No 
opium should be given during the continuance of these symptoms, 
but after their removal or mitigation, six grains of opium, and but 
once repeated, seem more successful than the frequent administra- 
tion of smaller quantities, which latter in many instances, seem to 
have increased the tendency to effusion. This, however, is a point 
not entirely settled. 

When a dry tongue occurs, even without great cerebral tendency, 
opium seems always to do mischief, by increasing the inflammation, 
which prevents its narcotic action. Calomel, or small quantities of 
blue mass, have sometimes seemed beneficial in exciting secretion, 
and removing the dryness of the tongue. Free purging, though very 
beneficial, when the head is alone affected, should be resorted to 
with much caution in inflammation of the stomach and intestines. 

Case I. — Robert Peacock, set. 35, had mania a potu once, has 
been drinking very hard for the last month, and slept out nearly every 
night. Admitted May 6th. Symptoms on admission were those of 
acute pleuritis connected with epileptic convulsions, (for the first 
time in his life,) which were relieved by cupping, blistering, purging, 
shaving the head, and constant application of cold water, with the 
occasional use of the following: — R. Lac. assafoetida, 5vj.; acet. 
tinct. opii, 5ij' But sleep not succeeding, on the third day mania a 
potu became developed. 

9th, Is very wild, constantly imagines that there is a rattlesnake 
running across the room, and persons with guns endeavouring to 
shoot it; occasionally jumping up and getting into the corner, in or- 
der, he says, to escape the shot which are fired at the snake. Head 
feels heavy, skin rather dry, pupils contracted, complains of pain 
about the umbilicus, pulse is full, with some force, 80 per minute. 
Ordered cups to seat of pain, and to the temples; four grains of 
opium every two hours. Afternoon. Is still very wild, face greatly 
flushed, covered with profuse perspiration; has only taken four 
grains of opium. Ordered cups to head to be repeated, and opium 
continued. 



334 Carter on Mania a Potu. 

10th. Took only four grains^ went to sleep very shortly after the 
cups were applied, and slept nearly all night, and on waking was 
more quiet and rational; bowels not open for two days past. Ordered 
B. Calomel, grs. x.; opium, gr. j.; and large bottle of porter — 10 
gtts. of acet. opii in each glass. Evening. Bowels not open, com- 
plains of slight pain in the head, other symptoms the same. Ordered 
cups again to head; injection of senna and salts; and xx. gtts. acet. 
opii every hour. 

11th. Took one hundred gtts. of acet. opii, slept about four hours, 
bowels opened three times. Complains of nausea, and pain on pres- 
sure in the epigastric region. Ordered cups to it, and the follow- 
ing: — Calomel, grs. iv.; opium, grs. ij.; q. b. h. Evening. Has 
taken twelve grains of calomel, bowels once opened, head is ex- 
cited, pulse has rather more force. Omit powders, and apply cups 
to head. 

12th. Slept some last night, head is still a little flighty; says he 
saw twenty persons last night, and is now occasionally talking to 
persons whom he imagines are present, though when spoken to, he 
answers very correctly; other symptoms are diminished. Ordered 
cups to head. 

13th. Slept some towards morning, still flighty, head hot, with 
some uneasiness. Ordered cups to be repeated to head. 

14th. Is now asleep, and slept nearly all last night. 

15th. Slept to-day and yesterday, says that he never felt better. 
Was soon afterwards discharged cured. 

Case II. — Margaret Robards, set. 40, has been long exposed to 
bodily and mental suffering. In order to drown them, she has been 
accustomed to drink excessively. For several weeks past she has 
been travelling, and is now very much exhausted. Has not slept any 
for several nights. Was admitted May 26th. She is now quite wild, 
but appears disposed to sleep. Ordered xl. gtts. acet. opii. 

9.Tth. Has slept none, was very wild all night, pulse is small, and 
rather feeble, 96 per minute, pupils contracted, skin moist, bowels 
open. Ordered cold to head; assafoetida mixt. q. b. h.; and blisters 
to the arms. Evening. Is very restless, afraid that we are going to 
injure her; epigastrium very tender upon pressure; tongue inclined 
to dryness; other symptoms the same. Ordered mustard plaster to 
stomach, and xxx. gtts. acet. opii, q. b. h. 

9>Sth. Was soon relieved by the plaster, and after taking 60 gtts. 
of acet. opii, went to sleep, and continues so now. Afternoon. Slept 
about eight hours, is still wild and restless, pulse small and weak. 



Carter on Mania a Potu. 335 

Ordered acet. opii, 30 gtts. q. b. h., to be alternated with the am- 
moniated julep, and with the free use of whiskey. Evening. No al- 
teration^ has taken 60 gtts. acet. opii. Ordered black drop to be 
omitted, and to take pulv. opii, q. b. h., with continuance of treat- 
ment. 10 P. M. Head considerably excited by the opium and sti- 
muli, face flushed, scalp hot, skin cold and dry. Omit opium; rub 
the skin with decoct, cantharides and turpentine; apply cold to head, 
and blisters to ankles. 

9,9tJi. Slept very little last night, but is now asleep. 

30//i. Slept very well last night, is now composed and rational. Is 
directed, in addition, some pepperpot. 

From this time she gradually recovered her strength by the conti- 
nuance of the generous diet, and occasional use of the diffusible sti- 
mulants, and was discharged cured in the course of a fortnight. 

Case III. — George Dormont, set. 35, admitted May 16th, 1829. 
Very intemperate, has been drinking very hard for two weeks, and 
has not slept any for the last three nights. Is now quite wild, ima- 
gines there are persons in the room who v*^ished to shoot him; skin 
warm and rather dry; pulse full and soft, 80 per minute; head hot; 
tongue moist and clean; pupils slightly dilated; bowels not open; 
considerable tenderness in the epigastrium. Ordered four cups to 
head, and four to epigastrium, with cold applications to head, injec- 
tion of senna and salts, immediately after four grains of opium and 
continue three every two hours. 

IQth. Has taken sixteen grains of opium; cups bled very freely; 
slept about two hours this morning; is still extremely wild; pupils 
contracted; bowels not open. Ordered, repeat cups to head, and 
senna injection. Afternoon. Resume opium, four grains every two 
hours. Evening. Having considerable cerebral tendency, six cups 
were repeated to head, and opium continued. 

17th. Took yesterday twenty-eight grains of opium; is more quiet; 
bowels only scantily opened. Ordered senna tea. Evening. Pulse 
soft and frequent; head free from cerebral excitement; skin moist and 
warm. The opium was resumed. 

18//i. Took eighteen grains of opium; slept very little; is very 
wild; says his head feels very well; pulse full, and of considerable 
force. Ordered, venesection §x. and continue opium. Afternoon. 
The blood drawn is cupped and buffed, with very little serum; pulse 
has risen in force. The orifice was again opened, and blood permit- 
ted to run until its tension was reduced, which required about §viij,; 
continue opium. 



336 Carter on Mania a Pom, 

19th, Slept at intervals three hours last nighty took yesterday 
thirty-two grains of opium; pulse is frequent and soft, 108 per mi- 
nute; is much calmer. Ordered a little porter. Evening. Has slept 
six hours during the day; is very restless; pulse has become rather 
tense. Ordered venesection §viij. and resume opium. 

20th, Took yesterday sixteen grains of opium; more quiet, and 
slept about four hours during the night; some excitement still re- 
maining. Ordered senna tea. 

24th. For several days he has been purged, and taken from forty 
to sixty drops of acet. opii at bed time; has slept generally very well; 
still some cerebral irritation; pulse full with considerable tension, 72 
per minute; mind yet wandering; is very fearful of dying. Ordered 
cups freely to head, which not relieving the excitement, he was in 
the evening bled ^xij. which reduced the volume, and increased its 
frequency to 90. 

25th, Mania still perceptible; head feels heavy and dull; tongue is 
slightly furred and red at the edges. Ordered, R. Blue mass, grs. v. 
at night. 

27th, Became quite wild. Is directed a shower bath, which though 
repeated, was only of temporary benefit, and as the pulse still pos- 
sessed some force and tension, he was bled ^xiv. ; omit the opiate, 
and continue blue mass. 

From this time, by the occasional use of cups, cathartics, and per- 
petual blisters to the back of the neck, and the steady continuance 
of the blue mass, his symptoms became gradually alleviated, when in 
about ten days, gentle ptyalism supervened, which entirely dissipat- 
ed his mania, and he was in a very short time restored to his usual 
health. 

For the following case I am indebted to my friend Dr. Ger- 
hard. James Love, set. 35, very muscular, not much exhaust- 
ed by his habits. Admitted September 1st. Pulse tense, frequent, 
and rather full; tongue moist, little furred; much head-ache; great 
nervous excitement; constantly making efforts to leave his bed; per- 
ception much less quick than usual; head hot. Cups were order- 
ed freely to temples and back of neck, cold applications to the 
head, and the following; R. Calomel, grs. xij.; pulv. rhei, 9j.; pulv. 
opii, gr. ij. The opium was used in small doses to prevent interfer- 
ing with the purge. Evening. Medicine has operated, but the patient 
more excited; pulse as before. Ordered venesection, §xij.; during 
the bleeding the pulse fell, the pain in the head diminished. The 
black drop was given, as no other complication existed. 



Smart's Case of Trismatic Tetanus. 337 

M, Improving; still some excitement in the head. Ordered assa- 
foetida mixture; cups to head — porter allowed. 

5c?. Patient delirious, but apparently with the usual form of mania 
a potu. Ordered opium, gr. iv. to be succeeded by gr. ij. every two 
hours. 

Ath. Determination to head, although he had enjoyed a short sleep. 
Ordered cups to back of the neck and head; calomel, grs. x. to be 
followed by senna tea. Evening. Medicine operated; less head-ache. 
E. Opium, grs. v. followed by grs. iv. every two hours. 

5th, Took last night twenty grains of opium; no sleep; pulse fee- 
ble. Ordered blisters to back of neck; porter and tinct. of hops al- 
lowed. Evening. Resume opium, when sleep followed, and recovery 
took place. 



Art. VI. Account of a Case of Trismatic Tetanus, produced by the 
Passage of large, rough, and angular pieces of Clay from the In 
testinal Canal into the Vagina, and Cured by Tobacco Injections. 
By Burleigh Smart, M. D. of Kennebunk, Maine. Read before 
the Medical Society of Maine, at its Semi-annual Meeting at Port- 
land, in January, 1825. 

IN March, 1824, I was requested to visit R. S. an unmarried fe- 
male, aged twenty-two years. On my entrance into her room, I was 
struck with the view of a pale, ghastly visage — the eyes rolled up, 
angles of the mouth retracted, nostrils drawn upward, and the cheeks 
backward, mouth closed— exhibiting altogether an expression of in- 
describable suffering. She was lying extended on her back, her head 
and heels only touching the bed, the spine recurvated into an arch 
of almost a semicircle — her jaws were locked. In about a minute 
the spasm subsided, and she swallowed with some difficulty, a tea- 
spoonful of oleum terebinthinse, from which she experienced immedi- 
ate relief. The dose of oil was repeated in about five minutes, in 
consequence of a partial return of the cramp, as the attendants term- 
ed it; which was that violent constriction and pain, darting from the 
ensiform cartilage to the spine and extensor muscles of the neck. 

During the intervals of the cramp, as she had but a few slight re- 
turns of the trismatic and tetanic spasms, she gave me the following 
history of her case: — she had been of a feeble constitution from in- 
fancy; three years ago her health became impaired, and she was af- 
fected with that erratic appetite, called by Good, limosis pica; to 

No. XII.— August, 1830. 30 



338 Smart's Case of Trismatic Tetanus, 

gratify which, she had eaten for a long time^ and in large quantities^ 
magnesia, chalk, and clay; this complaint was attended with a trou- 
blesome head-ache, and other marks of derangement of the functions 
of the digestive organs. 

She had menstruated irregularly, and the discharge was deficient 
in quantity and abnormal in quality. About a year ago, she became 
affected with sharp pains through the abdominal and uterine regions, 
accompanied with heavy bearing-down sensations, like parturient 
contractions of the uterus — swelling and exquisite tenderness of the 
abdomen — and retention of urine, requiring the repeated use of the 
catheter. After some weeks' suSering, she was attacked with trisma- 
tic tetanus; the trismus continued forty-eight hours, during which 
time the disease came on in paroxysms; a trait that it has constantly 
exhibited in every attack. 

The resolution of the first trismatic spasm was attributed to the 
use of prussic acid. 

About this time there was a discharge of a considerable quantity 
of foetid, purulent looking matter, per anum et vaginam; and after much 
suffering from th